Provider Demographics
NPI:1942455027
Name:KOEFERL, BETHANY JANE (PT)
Entity Type:Individual
Prefix:MRS
First Name:BETHANY
Middle Name:JANE
Last Name:KOEFERL
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 1:2 KEYSTONE COMMONS
Mailing Address - Street 2:
Mailing Address - City:BALLSTON LAKE
Mailing Address - State:NY
Mailing Address - Zip Code:12019-9300
Mailing Address - Country:US
Mailing Address - Phone:518-877-0389
Mailing Address - Fax:
Practice Address - Street 1:2 KEYSTONE COMMONS
Practice Address - Street 2:
Practice Address - City:BALLSTON LAKE
Practice Address - State:NY
Practice Address - Zip Code:12019-9300
Practice Address - Country:US
Practice Address - Phone:518-877-0389
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-17
Last Update Date:2008-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY012266-12251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics