MEDICARE: SHAUN A. KOTH P.T.

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	225100000X	Physical Therapist	4108	AZ

General Provider Information

NPI Number	:	1912952219
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHAUN A. KOTH P.T.

Provider Business Mailing Address
First Line	:	14287 N 87TH ST STE 220
Second Line	:
City	:	SCOTTSDALE
State	:	AZ
Zip	:	85260-3698
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	16968 W BELL RD # D401
Second Line	:
City	:	SURPRISE
State	:	AZ
Zip	:	85374-8943
Country	:	US
Telephone Number	:	623-299-9190
Fax Number	:	623-299-9191

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

Provider Enumeration Date	:	05/24/2006
Last Update Date	:	06/17/2025

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Directions to “ SHAUN A. KOTH P.T.” Practice Location

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