Healthcare Provider Details

I. General information

NPI: 1811413370
Provider Name (Legal Business Name): KARINA KOCH PT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/16/2017
Last Update Date: 08/16/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13609 CALIFORNIA ST STE 200
OMAHA NE
68154-5245
US

IV. Provider business mailing address

PO BOX 4553
GILLETTE WY
82717-4553
US

V. Phone/Fax

Practice location:
  • Phone: 402-891-1118
  • Fax:
Mailing address:
  • Phone: 307-680-2753
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number1017
License Number StateWY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: