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General NPI Number Information
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NPI Number | 1912586710
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Entity Type | Individual
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Provider Name | JONATHAN KOH
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Gender | Male
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Dates
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Enumeration Date | 04/07/2021
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Last Update Date | 02/10/2025
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Provider Practice Location Address
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Address Line | 3005 APACHE DR
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City | JONESBORO
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State | AR
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Zip | 72401-7432
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Country | US
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Telephone | 870-336-0238
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Fax |
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Provider Business Mailing Address
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Address Line | 2918 HAWKINS DR
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City | SEARCY
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State | AR
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Zip | 72143-4802
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Country | US
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Telephone | 501-279-9255
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225200000X
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Taxonomy Name | Physical Therapy Assistant
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License Number | 4456
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License Number State | AR
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