Provider Demographics
NPI:1962634824
Name:COFFEY, BRETT ANDREW (PTA)
Entity Type:Individual
Prefix:MR
First Name:BRETT
Middle Name:ANDREW
Last Name:COFFEY
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 1:5 BARTLETT RD
Mailing Address - Street 2:
Mailing Address - City:STRATHAM
Mailing Address - State:NH
Mailing Address - Zip Code:03885-2465
Mailing Address - Country:US
Mailing Address - Phone:603-770-7466
Mailing Address - Fax:
Practice Address - Street 1:22 TUCK RD
Practice Address - Street 2:
Practice Address - City:HAMPTON
Practice Address - State:NH
Practice Address - Zip Code:03842-1225
Practice Address - Country:US
Practice Address - Phone:603-926-4551
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-11
Last Update Date:2009-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH0956225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant