Provider Demographics
NPI:1861409526
Name:COUGHLIN, SCOTT THOMAS (MSPT)
Entity type:Individual
Prefix:
First Name:SCOTT
Middle Name:THOMAS
Last Name:COUGHLIN
Suffix:
Gender:M
Credentials:MSPT
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Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:17 CHARLES ST
Mailing Address - Street 2:SOUTHERN TIER PHYSICAL THERAPY OF BINGHAMTON
Mailing Address - City:BINGHAMTON
Mailing Address - State:NY
Mailing Address - Zip Code:13905-2224
Mailing Address - Country:US
Mailing Address - Phone:607-771-8181
Mailing Address - Fax:607-772-2899
Practice Address - Street 1:17 CHARLES ST
Practice Address - Street 2:SOUTHERN TIER PHYSICAL THERAPY OF BINGHAMTON, PC
Practice Address - City:BINGHAMTON
Practice Address - State:NY
Practice Address - Zip Code:13905-2224
Practice Address - Country:US
Practice Address - Phone:607-771-8181
Practice Address - Fax:607-772-2899
Is Sole Proprietor?:No
Enumeration Date:2006-08-02
Last Update Date:2008-10-23
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY027817225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02728292Medicaid
NYRA8903Medicare ID - Type Unspecified