Healthcare Provider Details

I. General information

NPI: 1316826191
Provider Name (Legal Business Name): LYDIA PEREZ KOCIS DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/27/2025
Last Update Date: 08/27/2025
Certification Date: 08/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 E 1ST ST
MORRIS MN
56267-1408
US

IV. Provider business mailing address

1697 FULHAM ST APT D
LAUDERDALE MN
55113-5248
US

V. Phone/Fax

Practice location:
  • Phone: 320-589-1313
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number14099
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: