Healthcare Provider Details

I. General information

NPI: 1194901306
Provider Name (Legal Business Name): JAMIE KOCHER PT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/17/2008
Last Update Date: 10/16/2023
Certification Date: 10/16/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16261 WESTWOODS BUSINESS PARK
ELLISVILLE MO
63021-4501
US

IV. Provider business mailing address

16243 PORT OF NANTUCKET DR
WILDWOOD MO
63040-1532
US

V. Phone/Fax

Practice location:
  • Phone: 314-614-8342
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: