Provider Demographics
NPI:1003321852
Name:KOCHER, JONATHON DUSTIN (MASSAGE THERAPIST)
Entity Type:Individual
Prefix:
First Name:JONATHON
Middle Name:DUSTIN
Last Name:KOCHER
Suffix:
Gender:M
Credentials:MASSAGE THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1002 MARTIN LUTHER KING JR WAY
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98405-4150
Mailing Address - Country:US
Mailing Address - Phone:253-750-3381
Mailing Address - Fax:253-267-1860
Practice Address - Street 1:1002 MARTIN LUTHER KING JR WAY
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98405-4150
Practice Address - Country:US
Practice Address - Phone:253-750-3381
Practice Address - Fax:253-267-1860
Is Sole Proprietor?:No
Enumeration Date:2017-12-01
Last Update Date:2017-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60806961225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist