Healthcare Provider Details

I. General information

NPI: 1568858835
Provider Name (Legal Business Name): AUSTIN KOCCHI DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/13/2015
Last Update Date: 04/13/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16838 E PALISADES BLVD BLDG B-121
FOUNTAIN HILLS AZ
85268-3786
US

IV. Provider business mailing address

PO BOX 4570
SCOTTSDALE AZ
85261-4570
US

V. Phone/Fax

Practice location:
  • Phone: 480-837-2595
  • Fax: 480-837-2773
Mailing address:
  • Phone: 480-551-4961
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number11360
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: