Healthcare Provider Details

I. General information

NPI: 1669642328
Provider Name (Legal Business Name): MARK KOFMAN MSPT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/08/2008
Last Update Date: 03/08/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

122 KINGSTON RD
CHELTENHAM PA
19012-1227
US

IV. Provider business mailing address

122 KINGSTON RD
CHELTENHAM PA
19012-1227
US

V. Phone/Fax

Practice location:
  • Phone: 267-250-7694
  • Fax: 215-782-3852
Mailing address:
  • Phone: 267-250-7694
  • Fax: 215-782-3852

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2251C2600X
TaxonomyCardiopulmonary Physical Therapist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code2251G0304X
TaxonomyGeriatric Physical Therapist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code2251N0400X
TaxonomyNeurology Physical Therapist
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: