Healthcare Provider Details

I. General information

NPI: 1386404390
Provider Name (Legal Business Name): ISABELLA KOCH PT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/19/2024
Last Update Date: 03/19/2024
Certification Date: 03/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

516 NE 64TH ST
MIAMI FL
33138-6132
US

IV. Provider business mailing address

516 NE 64TH ST
MIAMI FL
33138-6132
US

V. Phone/Fax

Practice location:
  • Phone: 305-209-1616
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251P0200X
TaxonomyPediatric Physical Therapist
License NumberPT40285
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: