Provider Demographics
NPI:1336203926
Name:COUGHLIN, ERIKA MCGEE (PT)
Entity Type:Individual
Prefix:MRS
First Name:ERIKA
Middle Name:MCGEE
Last Name:COUGHLIN
Suffix:
Gender:F
Credentials:PT
Other - Prefix:MS
Other - First Name:ERIKA
Other - Middle Name:LYNN
Other - Last Name:MCGEE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:3210 EVERGREEN AVE
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21214-2337
Mailing Address - Country:US
Mailing Address - Phone:443-919-1823
Mailing Address - Fax:
Practice Address - Street 1:210 E CENTRE ST
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21202-3619
Practice Address - Country:US
Practice Address - Phone:410-659-5990
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD21259225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDPT 21259OtherPT LICENSE NUMBER
MD216590Medicare ID - Type Unspecified