MEDICARE: JEFFREY L COON MPT

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	9800	CO

General Provider Information

NPI Number	:	1568784429
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JEFFREY L COON MPT

Provider Business Mailing Address
First Line	:	3209 MESA VERDE ST
Second Line	:
City	:	FORT COLLINS
State	:	CO
Zip	:	80525-9086
Country	:	US
Telephone Number	:	970-377-1784
Fax Number	:

Provider Business Practice Location Address
First Line	:	3209 MESA VERDE ST
Second Line	:
City	:	FORT COLLINS
State	:	CO
Zip	:	80525-9086
Country	:	US
Telephone Number	:	970-377-1784
Fax Number	:

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

Provider Enumeration Date	:	02/19/2010
Last Update Date	:	02/19/2010

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