Healthcare Provider Details

I. General information

NPI: 1093008732
Provider Name (Legal Business Name): DAVID B KOCH P.T.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/26/2011
Last Update Date: 05/26/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6545 E LARKSPUR DR
SCOTTSDALE AZ
85254-4527
US

IV. Provider business mailing address

6545 E LARKSPUR DR
SCOTTSDALE AZ
85254-4527
US

V. Phone/Fax

Practice location:
  • Phone: 602-373-8780
  • Fax: 480-699-4232
Mailing address:
  • Phone: 602-373-8780
  • Fax: 480-699-4232

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number1933
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: