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NPI Code Detail

MEDICARE: JUSTIN COFFEY

MEDICARE: JUSTIN COFFEY
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
1225100000XPhysical Therapist5501017907MI

General Provider Information

NPI Number : 1205302130
Entity Type Code : Individual
Provider Name (Legal Business Name) : JUSTIN COFFEY
Provider Business Mailing Address
First Line : 5625 WILDER RD
Second Line :
City : VASSAR
State : MI
Zip : 48768-9707
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 2415 5TH AVE S
Second Line :
City : ESCANABA
State : MI
Zip : 49829-1201
Country : US
Telephone Number : 906-786-6907
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/18/2018
Last Update Date : 10/18/2018

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Directions to “ JUSTIN COFFEY ” Practice Location

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