MEDICARE: MRS. LESLEY ANNE KOCH PT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2251X0800X	Orthopedic Physical Therapist	PT22736	CA

General Provider Information

NPI Number	:	1689646044
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. LESLEY ANNE KOCH PT

Provider Business Mailing Address
First Line	:	7451 WARNER AVE
Second Line	:	SUITE A
City	:	HUNTINGTON BEACH
State	:	CA
Zip	:	92647-5494
Country	:	US
Telephone Number	:	714-596-0700
Fax Number	:	714-596-0774

Provider Business Practice Location Address
First Line	:	7451 WARNER AVE
Second Line	:	SUITE A
City	:	HUNTINGTON BEACH
State	:	CA
Zip	:	92647-5494
Country	:	US
Telephone Number	:	714-596-0700
Fax Number	:	714-596-0774

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/01/2006
Last Update Date	:	10/12/2009

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