Healthcare Provider Details

I. General information

NPI: 1205861762
Provider Name (Legal Business Name): IRVIN KOCHEL III PT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/12/2006
Last Update Date: 09/08/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4770 LUCERNE RD
INDIANA PA
15701-6002
US

IV. Provider business mailing address

4770 LUCERNE RD
INDIANA PA
15701-6002
US

V. Phone/Fax

Practice location:
  • Phone: 724-840-5751
  • Fax: 724-801-8183
Mailing address:
  • Phone: 724-840-5751
  • Fax: 724-801-8183

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT006074L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: