Healthcare Provider Details

I. General information

NPI: 1619406311
Provider Name (Legal Business Name): JORDAN LEE KOCHER PT, DPT, CSCS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/06/2017
Last Update Date: 05/24/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

412 E 2ND ST
OWENSBORO KY
42303
US

IV. Provider business mailing address

PO BOX 3276
EVANSVILLE IN
47731-3276
US

V. Phone/Fax

Practice location:
  • Phone: 270-926-8145
  • Fax: 270-926-8147
Mailing address:
  • Phone: 812-473-0181
  • Fax: 812-473-5822

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number007341
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: