MEDICARE: DR. AIDAN SEAN KOFERL PT, DPT

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	225100000X	Physical Therapist	2305217084	VA
2	225100000X	Physical Therapist	CP052430T	MD

General Provider Information

NPI Number	:	1134013055
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. AIDAN SEAN KOFERL PT, DPT

Provider Business Mailing Address
First Line	:	PO BOX 179
Second Line	:
City	:	FOREST HILL
State	:	MD
Zip	:	21050-0179
Country	:	US
Telephone Number	:	240-245-5144
Fax Number	:	240-258-2082

Provider Business Practice Location Address
First Line	:	5600 RIVERTECH CT STE A-B
Second Line	:
City	:	RIVERDALE
State	:	MD
Zip	:	20737-1354
Country	:	US
Telephone Number	:	240-245-5144
Fax Number	:	240-258-2082

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

Provider Enumeration Date	:	06/05/2025
Last Update Date	:	01/20/2026

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