MEDICARE: MR. JEFFREY S COHEN M.P.T.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	PT24605	CA

General Provider Information

NPI Number	:	1710957576
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. JEFFREY S COHEN M.P.T.

Provider Business Mailing Address
First Line	:	21742 CHATHAM
Second Line	:
City	:	MISSION VIEJO
State	:	CA
Zip	:	92692-3068
Country	:	US
Telephone Number	:	949-951-4810
Fax Number	:	949-951-4810

Provider Business Practice Location Address
First Line	:	21742 CHATHAM
Second Line	:
City	:	MISSION VIEJO
State	:	CA
Zip	:	92692-3068
Country	:	US
Telephone Number	:	949-951-4810
Fax Number	:	949-951-4810

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/25/2006
Last Update Date	:	04/21/2008

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