Provider Demographics
NPI:1265564512
Name:VAN COUYGHEN, RENEE CAROL (MSPT)
Entity type:Individual
Prefix:
First Name:RENEE
Middle Name:CAROL
Last Name:VAN COUYGHEN
Suffix:
Gender:F
Credentials:MSPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25 WEST INDEPENDENCE WAY
Mailing Address - Street 2:SUITE J
Mailing Address - City:KINGSTON
Mailing Address - State:RI
Mailing Address - Zip Code:02881-0810
Mailing Address - Country:US
Mailing Address - Phone:401-567-5446
Mailing Address - Fax:401-874-5630
Practice Address - Street 1:25 W INDEPENDENCE WAY
Practice Address - Street 2:SUITE J PT DEPT
Practice Address - City:KINGSTON
Practice Address - State:RI
Practice Address - Zip Code:02881-1124
Practice Address - Country:US
Practice Address - Phone:401-567-5446
Practice Address - Fax:401-874-5630
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RI990225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist