MEDICARE: JEFFREY S COHEN

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	PT24605	CA

General Provider Information

NPI Number	:	1699824805
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JEFFREY S COHEN

Provider Business Mailing Address
First Line	:	21742 CHATHAM
Second Line	:
City	:	MISSION VIEJO
State	:	CA
Zip	:	92692-3068
Country	:	US
Telephone Number	:	949-951-4810
Fax Number	:	949-951-4810

Provider Business Practice Location Address
First Line	:	21742 CHATHAM
Second Line	:
City	:	MISSION VIEJO
State	:	CA
Zip	:	92692-3068
Country	:	US
Telephone Number	:	949-951-4810
Fax Number	:	949-951-4810

Authorized Official
Title or Position	:	OWNER
Name	:	MR. JEFFREY STEVEN COHEN
Credential	:	M.P.T.
Telephone Number	:	949-951-4810

Provider Enumeration Date	:	01/09/2007
Last Update Date	:	11/19/2012

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