Provider Demographics
NPI:1760753958
Name:COHEN, JONATHAN M (PTA)
Entity Type:Individual
Prefix:
First Name:JONATHAN
Middle Name:M
Last Name:COHEN
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2330 ALLEGHENY DR APT A
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80919-3058
Mailing Address - Country:US
Mailing Address - Phone:850-450-8077
Mailing Address - Fax:
Practice Address - Street 1:2330 ALLEGHENY DR APT A
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80919-3058
Practice Address - Country:US
Practice Address - Phone:850-450-8077
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-01-19
Last Update Date:2012-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant