Healthcare Provider Details

I. General information

NPI: 1821776139
Provider Name (Legal Business Name): CYNTHIA ROSE KOCH PHYSICAL THERAPIST
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/06/2023
Last Update Date: 09/23/2025
Certification Date: 09/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4200 18TH ST STE 102
SAN FRANCISCO CA
94114-2449
US

IV. Provider business mailing address

57 SANCHEZ ST APT 2
SAN FRANCISCO CA
94114-1118
US

V. Phone/Fax

Practice location:
  • Phone: 415-626-1929
  • Fax: 415-626-2607
Mailing address:
  • Phone: 415-269-9373
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License Number304331
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number304331
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: