MEDICARE: JONATHAN M COHEN PTA

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	225200000X	Physical Therapy Assistant		CO

General Provider Information

NPI Number	:	1760753958
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JONATHAN M COHEN PTA

Provider Business Mailing Address
First Line	:	2330 ALLEGHENY DR APT A
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80919-3058
Country	:	US
Telephone Number	:	850-450-8077
Fax Number	:

Provider Business Practice Location Address
First Line	:	2330 ALLEGHENY DR APT A
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80919-3058
Country	:	US
Telephone Number	:	850-450-8077
Fax Number	:

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

Provider Enumeration Date	:	01/19/2012
Last Update Date	:	01/19/2012

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