Provider Demographics
NPI:1639128374
Name:KOFFLER, PHILIP NATHAN (PT)
Entity Type:Individual
Prefix:
First Name:PHILIP
Middle Name:NATHAN
Last Name:KOFFLER
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1401 17TH ST
Mailing Address - Street 2:SUITE 475
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80202-1268
Mailing Address - Country:US
Mailing Address - Phone:303-515-2500
Mailing Address - Fax:303-515-2525
Practice Address - Street 1:1401 17TH ST
Practice Address - Street 2:SUITE 475
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80202-1268
Practice Address - Country:US
Practice Address - Phone:303-515-2500
Practice Address - Fax:303-515-2525
Is Sole Proprietor?:No
Enumeration Date:2006-05-09
Last Update Date:2012-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COPT 7838225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO1700169745OtherGROUP NPI
COC463148Medicare PIN