Provider Demographics
NPI:1255045316
Name:COUGHENOUR, EILEEN (DPT, CLT)
Entity type:Individual
Prefix:DR
First Name:EILEEN
Middle Name:
Last Name:COUGHENOUR
Suffix:
Gender:F
Credentials:DPT, CLT
Other - Prefix:
Other - First Name:EILEEN
Other - Middle Name:
Other - Last Name:HINTZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:12320 GLENWOOD ST
Mailing Address - Street 2:
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66209-2541
Mailing Address - Country:US
Mailing Address - Phone:913-645-3858
Mailing Address - Fax:
Practice Address - Street 1:12320 GLENWOOD ST
Practice Address - Street 2:
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66209-2541
Practice Address - Country:US
Practice Address - Phone:913-645-3858
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-12
Last Update Date:2023-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2017039588225100000X
KS11-04423225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist