Provider Demographics
NPI:1619343605
Name:COFFMAN, KATE R (PT)
Entity Type:Individual
Prefix:
First Name:KATE
Middle Name:R
Last Name:COFFMAN
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:KATE
Other - Middle Name:R
Other - Last Name:HASSE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:33900 HARPER AVE STE 104
Mailing Address - Street 2:
Mailing Address - City:CLINTON TOWNSHIP
Mailing Address - State:MI
Mailing Address - Zip Code:48035-4258
Mailing Address - Country:US
Mailing Address - Phone:586-350-2644
Mailing Address - Fax:
Practice Address - Street 1:27401 W IL ROUTE 22 STE 111
Practice Address - Street 2:
Practice Address - City:BARRINGTON
Practice Address - State:IL
Practice Address - Zip Code:60010-5934
Practice Address - Country:US
Practice Address - Phone:224-427-3330
Practice Address - Fax:224-427-3331
Is Sole Proprietor?:No
Enumeration Date:2015-08-13
Last Update Date:2024-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070021622225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist