Provider Demographics
NPI:1134181936
Name:KOFLER, MICHELLE L (PT)
Entity type:Individual
Prefix:MS
First Name:MICHELLE
Middle Name:L
Last Name:KOFLER
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:329 CONWAY ST
Mailing Address - Street 2:
Mailing Address - City:GREENFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01301-1521
Mailing Address - Country:US
Mailing Address - Phone:413-774-6301
Mailing Address - Fax:866-644-0871
Practice Address - Street 1:329 CONWAY ST
Practice Address - Street 2:
Practice Address - City:GREENFIELD
Practice Address - State:MA
Practice Address - Zip Code:01301-1521
Practice Address - Country:US
Practice Address - Phone:413-774-6301
Practice Address - Fax:866-644-0871
Is Sole Proprietor?:No
Enumeration Date:2006-04-05
Last Update Date:2024-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA13326225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1294745OtherFALLON COMMUNITY HEALTH PLAN
MAY67678OtherBLUE CROSS BLUE SHIELD
MA0332097Medicaid
MA470236OtherTUFTS HEALTH PLAN
MA24189OtherHEALTH NEW ENGLAND
MA626166OtherHARVARD PILGRIM HEALTH CA
MA712451OtherCONNECTICARE
MA2555053OtherAETNA/US HEALTHCARE
MA650020140OtherRAILROAD MEDICARE
MAY68645Medicare PIN
MA2555053OtherAETNA/US HEALTHCARE