MEDICARE: DEBRA COFER 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
1	2251P0200X	Pediatric Physical Therapist	PT001987	GA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1427183318
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DEBRA COFER PT

Provider Business Mailing Address
First Line	:	3565 AUSTELL RD SW
Second Line	:	SUITE 11
City	:	MARIETTA
State	:	GA
Zip	:	30008-5769
Country	:	US
Telephone Number	:	770-319-8000
Fax Number	:	770-319-8730

Provider Business Practice Location Address
First Line	:	3565 AUSTELL RD SW
Second Line	:	SUITE 11
City	:	MARIETTA
State	:	GA
Zip	:	30008-5769
Country	:	US
Telephone Number	:	770-319-8000
Fax Number	:	770-319-8730

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

Provider Enumeration Date	:	02/22/2007
Last Update Date	:	07/09/2007

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