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NPI Code Detail

MEDICARE: NATHAN DAVID KOCH PTA

MEDICARE: NATHAN DAVID KOCH PTA
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
1225200000XPhysical Therapy Assistant2131OK

General Provider Information

NPI Number : 1891134680
Entity Type Code : Individual
Provider Name (Legal Business Name) : NATHAN DAVID KOCH PTA
Provider Business Mailing Address
First Line : 2505 WOODTHRUSH RD
Second Line :
City : PONCA CITY
State : OK
Zip : 74604-2834
Country : US
Telephone Number : 918-805-9042
Fax Number :
Provider Business Practice Location Address
First Line : 1601 ACADEMY RD
Second Line :
City : PONCA CITY
State : OK
Zip : 74604-4409
Country : US
Telephone Number : 580-760-0927
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/14/2013
Last Update Date : 06/14/2013

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