Healthcare Provider Details

I. General information

NPI: 1568288744
Provider Name (Legal Business Name): KOEHLER PHYSIATRY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/03/2024
Last Update Date: 07/01/2025
Certification Date: 07/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7000 JEFFERSON ST NE
ALBUQUERQUE NM
87109-4313
US

IV. Provider business mailing address

PO BOX 6103
ALBUQUERQUE NM
87197-6103
US

V. Phone/Fax

Practice location:
  • Phone: 505-344-9478
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QR0401X
TaxonomyComprehensive Outpatient Rehabilitation Facility (CORF)
License Number
License Number State

VIII. Authorized Official

Name: DR. JONATHAN KOEHLER
Title or Position: OWNER
Credential: DO
Phone: 505-727-4725