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NPI Code Detail

MEDICARE: MICHAEL S KO DPT.,ATC

MEDICARE: MICHAEL S KO DPT.,ATC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1225100000XPhysical TherapistPT23590CA

General Provider Information

NPI Number : 1053492512
Entity Type Code : Individual
Provider Name (Legal Business Name) : MICHAEL S KO DPT.,ATC
Provider Business Mailing Address
First Line : 534 E PINE ST
Second Line : SUITE A
City : STOCKTON
State : CA
Zip : 95204-5536
Country : US
Telephone Number : 209-463-5800
Fax Number : 209-463-5900
Provider Business Practice Location Address
First Line : 534 E PINE ST
Second Line : SUITE A
City : STOCKTON
State : CA
Zip : 95204-5536
Country : US
Telephone Number : 209-463-5800
Fax Number : 209-463-5900
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/18/2006
Last Update Date : 04/24/2017

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