Provider Demographics
NPI:1467543736
Name:COFER, JAN D (PT)
Entity Type:Individual
Prefix:
First Name:JAN
Middle Name:D
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 1:8000 TOBIN PL
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27612-1915
Mailing Address - Country:US
Mailing Address - Phone:919-417-0801
Mailing Address - Fax:
Practice Address - Street 1:8000 TOBIN PL
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27612-1915
Practice Address - Country:US
Practice Address - Phone:919-417-0801
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-28
Last Update Date:2012-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN5333225100000X
NCP114752251G0304X
TX12041332251G0304X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251G0304XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGeriatrics
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3123654OtherBCBSTN
NC0446566Medicaid
TN0446566Medicaid
TN0446566Medicaid
NC0446566Medicaid