Active NPI
Suzanne S Coffman, PT
- Physical Therapist
- Fairmont, WV
National Provider Identifier
1376646430
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 133
- Practice address
- 1322 Locust Ave
Fairmont, WV 26554 - Phone
- (304) 367-8740
- Fax
- (304) 366-9529
- NPI assigned
- Sep 6, 2006
- 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 | 133 | WV | Primary |
Addresses
Primary practice location
1322 Locust Ave
Fairmont, WV 26554
Mailing address
RR 4 Box 286
Grafton, WV 26354
Phone (304) 265-5643
Other identifiers 3
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 001718501 | Other | WV | BLUE CROSS BLUE SHIELD |
| 55041919103 | Other | WV | BRICKSTREET |
| 0156077001 | Medicaid | WV |
Other names 1
- Mrs. Suzanne S Souther
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 133 | OH | MD | Registered Dietitian |
| 133 | WV | MD | Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1157500800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1347235200000",
"number": "1376646430",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "RR 4 BOX 286",
"city": "GRAFTON",
"state": "WV",
"postal_code": "26354",
"telephone_number": "304-265-5643"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1322 LOCUST AVE",
"city": "FAIRMONT",
"state": "WV",
"postal_code": "26554",
"telephone_number": "304-367-8740",
"fax_number": "304-366-9529"
}
],
"practiceLocations": [],
"basic": {
"last_name": "COFFMAN",
"first_name": "SUZANNE",
"middle_name": "S",
"name_prefix": "Mrs.",
"credential": "PT",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-09-06",
"last_updated": "2012-09-10",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "WV",
"license": "133",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE CROSS BLUE SHIELD",
"identifier": "001718501",
"state": "WV"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BRICKSTREET",
"identifier": "55041919103",
"state": "WV"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "0156077001",
"state": "WV"
}
],
"endpoints": [],
"other_names": [
{
"first_name": "SUZANNE",
"last_name": "SOUTHER",
"middle_name": "S",
"prefix": "MRS.",
"credential": "PT",
"code": "1",
"type": "Former Name"
}
]
}Other providers in Fairmont, WV
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 10, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.