Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251P0200X | Physical Therapist - Pediatrics | 3491 | AR |
NPI | 1063762615 |
---|---|
Provider Name | Juliette M Coughlin |
First Address | Little Rock, AR 72212 |
Second Address | Little Rock, AR 72212 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/09/2012 |
Last Update Date | 11/09/2012 |