Provider Demographics
NPI:1780674291
Name:COUGHLIN, ANNE O (PT)
Entity type:Individual
Prefix:
First Name:ANNE
Middle Name:O
Last Name:COUGHLIN
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 1:999 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:AKRON
Mailing Address - State:OH
Mailing Address - Zip Code:44310-1456
Mailing Address - Country:US
Mailing Address - Phone:330-929-2694
Mailing Address - Fax:330-929-2782
Practice Address - Street 1:999 N MAIN ST
Practice Address - Street 2:
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44310-1456
Practice Address - Country:US
Practice Address - Phone:330-929-2694
Practice Address - Fax:330-929-2782
Is Sole Proprietor?:No
Enumeration Date:2005-10-26
Last Update Date:2008-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPT06413225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2731762Medicaid
4173404Medicare PIN
4173405Medicare PIN
4173403Medicare PIN