Healthcare Provider Details

I. General information

NPI: 1336989730
Provider Name (Legal Business Name): LINDSAY KOCH RD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/31/2024
Last Update Date: 06/04/2024
Certification Date: 06/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

744 E LINCOLN HWY STE 110
COATESVILLE PA
19320-3590
US

IV. Provider business mailing address

1247 TYLER AVE
PHOENIXVILLE PA
19460-4364
US

V. Phone/Fax

Practice location:
  • Phone: 610-380-4660
  • Fax:
Mailing address:
  • Phone: 610-908-4218
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License NumberDN008315
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: