Provider Demographics
NPI:1457939340
Name:COUGHLAN, CONOR PATRICK (PT, DPT)
Entity Type:Individual
Prefix:
First Name:CONOR
Middle Name:PATRICK
Last Name:COUGHLAN
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:344 OCEAN AVE
Mailing Address - Street 2:
Mailing Address - City:MASSAPEQUA PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11762-1813
Mailing Address - Country:US
Mailing Address - Phone:516-816-0328
Mailing Address - Fax:
Practice Address - Street 1:19266 COASTAL HWY
Practice Address - Street 2:
Practice Address - City:REHOBOTH BEACH
Practice Address - State:DE
Practice Address - Zip Code:19971-6117
Practice Address - Country:US
Practice Address - Phone:302-226-2230
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-31
Last Update Date:2021-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist