Healthcare Provider Details

I. General information

NPI: 1639128374
Provider Name (Legal Business Name): PHILIP NATHAN KOFFLER P.T.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/09/2006
Last Update Date: 10/08/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1401 17TH ST SUITE 475
DENVER CO
80202-1268
US

IV. Provider business mailing address

1401 17TH ST SUITE 475
DENVER CO
80202-1268
US

V. Phone/Fax

Practice location:
  • Phone: 303-515-2500
  • Fax: 303-515-2525
Mailing address:
  • Phone: 303-515-2500
  • Fax: 303-515-2525

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT 7838
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: