Provider Demographics
NPI:1720160799
Name:COEN, CARRIE ANN (PT)
Entity Type:Individual
Prefix:MRS
First Name:CARRIE
Middle Name:ANN
Last Name:COEN
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 1:678 SOUTHWAY AVE
Mailing Address - Street 2:
Mailing Address - City:LEWISTON
Mailing Address - State:ID
Mailing Address - Zip Code:83501-3783
Mailing Address - Country:US
Mailing Address - Phone:208-746-1418
Mailing Address - Fax:208-746-4123
Practice Address - Street 1:678 SOUTHWAY AVE
Practice Address - Street 2:
Practice Address - City:LEWISTON
Practice Address - State:ID
Practice Address - Zip Code:83501-3783
Practice Address - Country:US
Practice Address - Phone:208-746-1418
Practice Address - Fax:208-746-4123
Is Sole Proprietor?:No
Enumeration Date:2006-10-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID7023864OtherWAPA
ID0112038OtherWA LI
ID390090OtherREGENCE GROUP
ID8B263OtherBCID
ID1000927OtherCHAMPUS/BLUECROSS
ID7023864OtherWAPA