Healthcare Provider Details

I. General information

NPI: 1104457381
Provider Name (Legal Business Name): KOCH PHYSICAL THERAPY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/28/2020
Last Update Date: 01/28/2020
Certification Date: 01/28/2020
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 Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. DAVID KOCH
Title or Position: OWNER
Credential: PT
Phone: 602-373-8780