Provider Demographics
NPI:1013081066
Name:KOEHLER, MARTIN H (MPT)
Entity Type:Individual
Prefix:MR
First Name:MARTIN
Middle Name:H
Last Name:KOEHLER
Suffix:
Gender:M
Credentials:MPT
Other - Prefix:MR
Other - First Name:MARTIN
Other - Middle Name:H
Other - Last Name:KOEHLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MPT
Mailing Address - Street 1:2600 STANWELL DRIVE
Mailing Address - Street 2:SUITE 104
Mailing Address - City:CONCORD
Mailing Address - State:CA
Mailing Address - Zip Code:94520-4862
Mailing Address - Country:US
Mailing Address - Phone:925-686-5400
Mailing Address - Fax:925-686-3709
Practice Address - Street 1:2600 STANWELL DRIVE
Practice Address - Street 2:SUITE 104
Practice Address - City:CONCORD
Practice Address - State:CA
Practice Address - Zip Code:94520-4862
Practice Address - Country:US
Practice Address - Phone:925-686-5400
Practice Address - Fax:925-686-3709
Is Sole Proprietor?:No
Enumeration Date:2006-11-20
Last Update Date:2008-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA30084225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ26603ZMedicare PIN