Healthcare Provider Details

I. General information

NPI: 1770693509
Provider Name (Legal Business Name): KRISTINA MARIE KOCH MPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KRISTINA MARIE GRAY MPT

II. Dates (important events)

Enumeration Date: 08/30/2006
Last Update Date: 01/28/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5265 N ACADEMY BLVD #1500
COLORADO SPRINGS CO
80918-4060
US

IV. Provider business mailing address

13085 CRANE CANYON LOOP
COLORADO SPRINGS CO
80921-7217
US

V. Phone/Fax

Practice location:
  • Phone: 719-694-8342
  • Fax: 719-694-8347
Mailing address:
  • Phone: 619-578-4362
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT25297
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code2251G0304X
TaxonomyGeriatric Physical Therapist
License NumberPT25297
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: