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NPI Code Detail

MEDICARE: MR. JEFFREY A KOESTER PT

MEDICARE: MR. JEFFREY A KOESTER PT
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 Therapist070-004611IL

General Provider Information

NPI Number : 1245480136
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. JEFFREY A KOESTER PT
Provider Business Mailing Address
First Line : 3631 S 6TH ST
Second Line :
City : SPRINGFIELD
State : IL
Zip : 62703-4777
Country : US
Telephone Number : 217-535-3685
Fax Number : 217-529-0988
Provider Business Practice Location Address
First Line : 800 N 1ST ST
Second Line :
City : SPRINGFIELD
State : IL
Zip : 62702-3778
Country : US
Telephone Number : 217-528-7541
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/26/2008
Last Update Date : 06/18/2020

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Directions to “ MR. JEFFREY A KOESTER PT” Practice Location

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