Provider Demographics
NPI:1023432994
Name:COOGAN, NATHAN EDWARD (LMT)
Entity type:Individual
Prefix:MR
First Name:NATHAN
Middle Name:EDWARD
Last Name:COOGAN
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:4879 OLD BUFFALO RD
Mailing Address - Street 2:
Mailing Address - City:WARSAW
Mailing Address - State:NY
Mailing Address - Zip Code:14569-9562
Mailing Address - Country:US
Mailing Address - Phone:585-315-6812
Mailing Address - Fax:585-786-2842
Practice Address - Street 1:4879 OLD BUFFALO RD
Practice Address - Street 2:
Practice Address - City:WARSAW
Practice Address - State:NY
Practice Address - Zip Code:14569-9562
Practice Address - Country:US
Practice Address - Phone:585-315-6812
Practice Address - Fax:585-786-2842
Is Sole Proprietor?:No
Enumeration Date:2014-02-12
Last Update Date:2014-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY027560225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist