Provider Demographics
NPI:1669642328
Name:KOFMAN, MARK (MSPT)
Entity Type:Individual
Prefix:MR
First Name:MARK
Middle Name:
Last Name:KOFMAN
Suffix:
Gender:M
Credentials:MSPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:122 KINGSTON RD
Mailing Address - Street 2:
Mailing Address - City:CHELTENHAM
Mailing Address - State:PA
Mailing Address - Zip Code:19012-1227
Mailing Address - Country:US
Mailing Address - Phone:267-250-7694
Mailing Address - Fax:215-782-3852
Practice Address - Street 1:122 KINGSTON RD
Practice Address - Street 2:
Practice Address - City:CHELTENHAM
Practice Address - State:PA
Practice Address - Zip Code:19012-1227
Practice Address - Country:US
Practice Address - Phone:267-250-7694
Practice Address - Fax:215-782-3852
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-08
Last Update Date:2008-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251G0304XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGeriatrics
No2251C2600XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistCardiopulmonary
No2251N0400XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistNeurology
No2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic