1790001238 NPI number — DINA COONEY DPT

Table of content: DINA COONEY DPT (NPI 1790001238)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1790001238 NPI number — DINA COONEY DPT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
COONEY
Provider First Name:
DINA
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
DPT
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
DETLING
Provider Other First Name:
DINA
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
DPT
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1790001238
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/02/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1 MEDICAL PARK
Provider Second Line Business Mailing Address:
PATIENT ACCOUNTING - CREDENTIALING
Provider Business Mailing Address City Name:
WHEELING
Provider Business Mailing Address State Name:
WV
Provider Business Mailing Address Postal Code:
26003-6379
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
304-243-3124
Provider Business Mailing Address Fax Number:
304-243-1131

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
WHEELING HOSPITAL PEDIATRIC REHABILITATION
Provider Second Line Business Practice Location Address:
210 ANTHONI AVENUE STE. 2
Provider Business Practice Location Address City Name:
WHEELING
Provider Business Practice Location Address State Name:
WV
Provider Business Practice Location Address Postal Code:
26003-6403
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
304-243-8310
Provider Business Practice Location Address Fax Number:
304-243-8430
Provider Enumeration Date:
04/08/2010

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 2251P0200X , with the licence number:  002671 , registered in the state of WV ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 002671 . This is a "PHYSICAL THERAPIST LICENSE" identifier , issued by the state of ( WV ) . This identifiers is of the category "OTHER".




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