Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 2251C2600X | Cardiopulmonary | ||
Y | 2251G0304X | Physical Therapist - Geriatrics | ||
N | 2251N0400X | Physical Therapist - Neurology | ||
N | 2251X0800X | Physical Therapist - Orthopedic |
NPI | 1669642328 |
---|---|
Provider Name | Mr. Mark Kofman |
First Address | Cheltenham, PA 19012-1227 |
Second Address | Cheltenham, PA 19012-1227 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 08/03/2008 |
Last Update Date | 08/03/2008 |