Provider Demographics
NPI:1427183318
Name:COFER, DEBRA (PT)
Entity Type:Individual
Prefix:
First Name:DEBRA
Middle Name:
Last Name:COFER
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3565 AUSTELL RD SW
Mailing Address - Street 2:SUITE 11
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30008-5769
Mailing Address - Country:US
Mailing Address - Phone:770-319-8000
Mailing Address - Fax:770-319-8730
Practice Address - Street 1:3565 AUSTELL RD SW
Practice Address - Street 2:SUITE 11
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30008-5769
Practice Address - Country:US
Practice Address - Phone:770-319-8000
Practice Address - Fax:770-319-8730
Is Sole Proprietor?:No
Enumeration Date:2007-02-22
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPT0019872251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00560106CMedicaid