Provider Demographics
NPI:1134283674
Name:KOCH, LEE (PT)
Entity Type:Individual
Prefix:
First Name:LEE
Middle Name:
Last Name:KOCH
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:6410 ROCKLEDGE DR
Mailing Address - Street 2:NRH REGIONAL REHAB - SUITE 600
Mailing Address - City:BETHESDA
Mailing Address - State:MD
Mailing Address - Zip Code:20817-1809
Mailing Address - Country:US
Mailing Address - Phone:301-581-8054
Mailing Address - Fax:301-564-0284
Practice Address - Street 1:2410 EVERGREEN RD STE 100
Practice Address - Street 2:
Practice Address - City:GAMBRILLS
Practice Address - State:MD
Practice Address - Zip Code:21054-1979
Practice Address - Country:US
Practice Address - Phone:410-451-8150
Practice Address - Fax:410-451-8151
Is Sole Proprietor?:No
Enumeration Date:2006-12-20
Last Update Date:2024-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD190182251X0800X, 225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic