Provider Demographics
NPI:1821146366
Name:COFFMAN, MICHELLE (PT)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:
Last Name:COFFMAN
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1215 SE 8TH AVE STE D
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97214-3497
Mailing Address - Country:US
Mailing Address - Phone:503-208-4360
Mailing Address - Fax:503-200-1148
Practice Address - Street 1:1215 SE 8TH AVE STE D
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97214-3497
Practice Address - Country:US
Practice Address - Phone:503-208-4360
Practice Address - Fax:503-200-1148
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-08
Last Update Date:2022-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT00009569225100000X
OR30182251X0800X, 225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR103710Medicare ID - Type UnspecifiedMEDICARE NUMBER