Provider Demographics
NPI:1386498004
Name:COFFMAN, KATHRYN ANN (DPT)
Entity type:Individual
Prefix:
First Name:KATHRYN
Middle Name:ANN
Last Name:COFFMAN
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1650 COUNTY LINE RD
Mailing Address - Street 2:
Mailing Address - City:GATES MILLS
Mailing Address - State:OH
Mailing Address - Zip Code:44040-9800
Mailing Address - Country:US
Mailing Address - Phone:216-310-4086
Mailing Address - Fax:
Practice Address - Street 1:3705 STATE RD # 102
Practice Address - Street 2:
Practice Address - City:ASHTABULA
Practice Address - State:OH
Practice Address - Zip Code:44004-5904
Practice Address - Country:US
Practice Address - Phone:440-260-7670
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-17
Last Update Date:2024-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPT020955225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist