Healthcare Provider Details

I. General information

NPI: 1376935106
Provider Name (Legal Business Name): JOHN DAVID KOFMEHL PT, DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/03/2015
Last Update Date: 03/03/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

102 IRVING ST NW FIRST FLOOR, OUTPATIENT GYM
WASHINGTON DC
20010-2921
US

IV. Provider business mailing address

231 8TH ST NE
WASHINGTON DC
20002-6105
US

V. Phone/Fax

Practice location:
  • Phone: 412-860-4850
  • Fax:
Mailing address:
  • Phone: 412-860-4850
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251N0400X
TaxonomyNeurology Physical Therapist
License NumberPT871296
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: