Provider Demographics
NPI:1306137716
Name:COHEN, MARC I (DPT)
Entity type:Individual
Prefix:DR
First Name:MARC
Middle Name:I
Last Name:COHEN
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1760 E KEN PRATT BLVD STE 405
Mailing Address - Street 2:
Mailing Address - City:LONGMONT
Mailing Address - State:CO
Mailing Address - Zip Code:80504-5311
Mailing Address - Country:US
Mailing Address - Phone:720-718-5400
Mailing Address - Fax:720-718-5991
Practice Address - Street 1:1760 E KEN PRATT BLVD STE 405
Practice Address - Street 2:
Practice Address - City:LONGMONT
Practice Address - State:CO
Practice Address - Zip Code:80504-5311
Practice Address - Country:US
Practice Address - Phone:720-718-5400
Practice Address - Fax:720-718-5991
Is Sole Proprietor?:No
Enumeration Date:2011-04-20
Last Update Date:2022-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO8735225100000X
DEJ1-0002687225100000X
COPTL.0008735225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
DEG00716Medicare PIN
DE218121ZBSXMedicare PIN