Provider Demographics
NPI:1760783559
Name:COFFEY, SUSAN (LMT)
Entity Type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:
Last Name:COFFEY
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2514 W COLORADO AVE
Mailing Address - Street 2:202
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80904-3071
Mailing Address - Country:US
Mailing Address - Phone:719-692-7315
Mailing Address - Fax:
Practice Address - Street 1:2514 W COLORADO AVE
Practice Address - Street 2:202
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80904-3071
Practice Address - Country:US
Practice Address - Phone:719-692-7315
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-09
Last Update Date:2016-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO7050172M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172M00000XOther Service ProvidersMechanotherapist