Provider Demographics
NPI:1811061401
Name:COON, WILLIAM JAMES (ATC, PTA, CSCS, EMT)
Entity type:Individual
Prefix:MR
First Name:WILLIAM
Middle Name:JAMES
Last Name:COON
Suffix:
Gender:M
Credentials:ATC, PTA, CSCS, EMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:60 HAWLEY AVE
Mailing Address - Street 2:UNIT # 3
Mailing Address - City:MILFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06460-8116
Mailing Address - Country:US
Mailing Address - Phone:203-283-1085
Mailing Address - Fax:
Practice Address - Street 1:199 WHITNEY AVE
Practice Address - Street 2:
Practice Address - City:NEW HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06511-3786
Practice Address - Country:US
Practice Address - Phone:203-789-8873
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-17
Last Update Date:2008-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000022146N00000X
CT000996225200000X
CT0003902255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant
No146N00000XEmergency Medical Service ProvidersEmergency Medical Technician, Basic
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer