Healthcare Provider Details

I. General information

NPI: 1417385915
Provider Name (Legal Business Name): AMY KOCH PT, CMPT, COMT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/18/2013
Last Update Date: 02/25/2025
Certification Date: 02/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11336 S 96TH ST STE 114
PAPILLION NE
68046-4211
US

IV. Provider business mailing address

PO BOX 3755
OMAHA NE
68103-0755
US

V. Phone/Fax

Practice location:
  • Phone: 402-315-3603
  • Fax: 402-718-9973
Mailing address:
  • Phone: 402-354-2100
  • Fax: 402-354-2155

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number2511
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: