Healthcare Provider Details

I. General information

NPI: 1144552381
Provider Name (Legal Business Name): JOYANN KOCH DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JOYANN FRIES DPT

II. Dates (important events)

Enumeration Date: 02/12/2010
Last Update Date: 09/22/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1893 MONTEREY RD STE 200
SAN JOSE CA
95112-6137
US

IV. Provider business mailing address

1893 MONTEREY RD STE 200
SAN JOSE CA
95112-6137
US

V. Phone/Fax

Practice location:
  • Phone: 408-288-3815
  • Fax:
Mailing address:
  • Phone: 408-288-3815
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number17326
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number36787
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: