Active NPI
Colin G Coughenour, CPT
- Kinesiotherapist
- Petaluma, CA
National Provider Identifier
1659605574
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Kinesiotherapist
- License
- ACE - T145486
- Practice address
- 18 Warrick CT
Petaluma, CA 94954-5848 - Phone
- (707) 217-7838
- NPI assigned
- Sep 24, 2009
- Last updated
- Sep 24, 2009
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Nutritionist | 133N00000X | ACE - T145486 | CA | |
| Kinesiotherapist | 226300000X | ACE - T145486 | CA | Primary |
Addresses
Primary practice location
18 Warrick CT
Petaluma, CA 94954-5848
Mailing address
18 Warrick CT
Petaluma, CA 94954-5848
Phone (707) 217-7838
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)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| ACE - T145486 | CA | MD | Kinesiotherapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1253750400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1253750400000",
"number": "1659605574",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "18 WARRICK CT",
"city": "PETALUMA",
"state": "CA",
"postal_code": "949545848",
"telephone_number": "707-217-7838"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "18 WARRICK CT",
"city": "PETALUMA",
"state": "CA",
"postal_code": "949545848",
"telephone_number": "707-217-7838"
}
],
"practiceLocations": [],
"basic": {
"last_name": "COUGHENOUR",
"first_name": "COLIN",
"middle_name": "G",
"credential": "CPT",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2009-09-24",
"last_updated": "2009-09-24",
"status": "A"
},
"taxonomies": [
{
"code": "133N00000X",
"taxonomy_group": "",
"desc": "Nutritionist",
"state": "CA",
"license": "ACE - T145486",
"primary": false
},
{
"code": "226300000X",
"taxonomy_group": "",
"desc": "Kinesiotherapist",
"state": "CA",
"license": "ACE - T145486",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Petaluma, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 24, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.