Basic Information
| Provider Information | |||||||||
| NPI: | 1326423054 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | COFFMAN | ||||||||
| FirstName: | RACHEL | ||||||||
| MiddleName: | |||||||||
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| OtherLastName: | TARINI | ||||||||
| OtherFirstName: | RACHEL | ||||||||
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| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 1625 STRAITS TURNPIKE | ||||||||
| Address2: | SUITE 300 | ||||||||
| City: | MIDDLEBURY | ||||||||
| State: | CT | ||||||||
| PostalCode: | 067621805 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2035986066 | ||||||||
| FaxNumber: | 2035983300 | ||||||||
| Practice Location | |||||||||
| Address1: | 22 TOMPKINS ST | ||||||||
| Address2: | |||||||||
| City: | WATERBURY | ||||||||
| State: | CT | ||||||||
| PostalCode: | 067081458 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2034190381 | ||||||||
| FaxNumber: | 2034190389 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/23/2015 | ||||||||
| LastUpdateDate: | 11/09/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 11/09/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 10213 | CT | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
ID Information
| ID | Type | State | Issuer | Description | 004190328 | 05 | CT | MEDICAID |