Active NPI
Mary Elizabeth Coughlin, P.T.
- Physical Therapist
- Charlottesville, VA
National Provider Identifier
1063504082
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 2305204980
- Practice address
- 967 Pintail Lane
Charlottesville, VA 22903-9616 - Phone
- (434) 284-2550
- NPI assigned
- Sep 28, 2006
- Last updated
- Aug 2, 2011
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | 2305204980 | VA | Primary |
Addresses
Primary practice location
967 Pintail Lane
Charlottesville, VA 22903-9616
Mailing address
967 Pintail LN
Charlottesville, VA 22903-9616
Phone (434) 284-2550
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 2305204980 | Other | VA | STATE OF VIRGINIA PHYSICAL THERAPY LICENSE NUMBER |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1159401600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1312243200000",
"number": "1063504082",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "967 PINTAIL LN",
"city": "CHARLOTTESVILLE",
"state": "VA",
"postal_code": "229039616",
"telephone_number": "434-284-2550"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "967 PINTAIL LANE",
"city": "CHARLOTTESVILLE",
"state": "VA",
"postal_code": "229039616",
"telephone_number": "434-284-2550"
}
],
"practiceLocations": [],
"basic": {
"last_name": "COUGHLIN",
"first_name": "MARY",
"middle_name": "ELIZABETH",
"credential": "P.T.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-09-28",
"last_updated": "2011-08-02",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "VA",
"license": "2305204980",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "STATE OF VIRGINIA PHYSICAL THERAPY LICENSE NUMBER",
"identifier": "2305204980",
"state": "VA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Charlottesville, VA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 2, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.