Healthcare Provider Details

I. General information

NPI: 1962706705
Provider Name (Legal Business Name): DEREK LEWIS KOCHER PT, DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/10/2011
Last Update Date: 01/10/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1001 W BALTIMORE ST
MCMECHEN WV
26040-1503
US

IV. Provider business mailing address

3 SHERWOOD AVE
WHEELING WV
26003-5044
US

V. Phone/Fax

Practice location:
  • Phone: 304-242-4004
  • Fax:
Mailing address:
  • Phone: 304-771-8982
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number2802
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: