MEDICARE: MR. JOEL STEPHEN COFFMAN P.T.

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	2001018653	MO
2	225100000X	Physical Therapist	11-03087	KS

General Provider Information

NPI Number	:	1598104341
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. JOEL STEPHEN COFFMAN P.T.

Provider Business Mailing Address
First Line	:	1650 BROADWAY ST
Second Line	:
City	:	KANSAS CITY
State	:	MO
Zip	:	64108-1208
Country	:	US
Telephone Number	:	816-842-2020
Fax Number	:	816-842-2906

Provider Business Practice Location Address
First Line	:	1650 BROADWAY ST
Second Line	:
City	:	KANSAS CITY
State	:	MO
Zip	:	64108-1208
Country	:	US
Telephone Number	:	816-842-2020
Fax Number	:	816-842-2906

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

Provider Enumeration Date	:	06/14/2013
Last Update Date	:	06/14/2013

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