Provider Demographics
NPI:1952313223
Name:COUSSOULE, HELEN (PT)
Entity Type:Individual
Prefix:
First Name:HELEN
Middle Name:
Last Name:COUSSOULE
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:205 EAST 64TH STREET
Mailing Address - Street 2:SUITE 402
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10021
Mailing Address - Country:US
Mailing Address - Phone:212-759-4460
Mailing Address - Fax:212-759-1353
Practice Address - Street 1:205 E 64TH ST
Practice Address - Street 2:SUITE 402
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10065-6635
Practice Address - Country:US
Practice Address - Phone:212-759-4460
Practice Address - Fax:212-759-1353
Is Sole Proprietor?:No
Enumeration Date:2006-08-13
Last Update Date:2012-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY021179225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYQC2181Medicare ID - Type Unspecified
NYQC218Q49E1Medicare PIN
NYA40067900Medicare PIN