Healthcare Provider Details

I. General information

NPI: 1528250578
Provider Name (Legal Business Name): APRIL JEANNE KOCH M.P.T.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/14/2007
Last Update Date: 07/16/2020
Certification Date: 07/16/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

401 BICENTENNIAL WAY
SANTA ROSA CA
95403-2149
US

IV. Provider business mailing address

1010 ALEPPO DR
SANTA ROSA CA
95409-5509
US

V. Phone/Fax

Practice location:
  • Phone: 918-557-5245
  • Fax:
Mailing address:
  • Phone: 918-557-5245
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT3997
License Number StateOK
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number43152
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: