Healthcare Provider Details

I. General information

NPI: 1457539199
Provider Name (Legal Business Name): JESSALYN CIAMPA KOCH DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/05/2008
Last Update Date: 01/13/2025
Certification Date: 01/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1270 BELMONT AVE
SCHENECTADY NY
12308-2104
US

IV. Provider business mailing address

1270 BELMONT AVE
SCHENECTADY NY
12308-2104
US

V. Phone/Fax

Practice location:
  • Phone: 518-386-3552
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number053283-01
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: