Healthcare Provider Details

I. General information

NPI: 1376608968
Provider Name (Legal Business Name): PAUL KOCHOA P.T., D.P.T.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/26/2006
Last Update Date: 05/09/2023
Certification Date: 05/09/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1572 SUSSEX TPKE UNIT D
RANDOLPH NJ
07869-1822
US

IV. Provider business mailing address

300 MAIN ST STE 21
MADISON NJ
07940-2369
US

V. Phone/Fax

Practice location:
  • Phone: 347-746-9423
  • Fax:
Mailing address:
  • Phone: 347-746-9423
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number40QAO1402300
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: