Provider Demographics
NPI:1144389701
Name:KOH PHYSICAL THERAPY, INC.
Entity Type:Organization
Organization Name:KOH PHYSICAL THERAPY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:DAVIS
Authorized Official - Middle Name:Y
Authorized Official - Last Name:KOH
Authorized Official - Suffix:
Authorized Official - Credentials:DPT, MBA, GCS, CSCS
Authorized Official - Phone:949-540-5641
Mailing Address - Street 1:9080 IRVINE CENTER DR
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92618-4658
Mailing Address - Country:US
Mailing Address - Phone:949-540-5641
Mailing Address - Fax:949-540-5642
Practice Address - Street 1:9080 IRVINE CENTER DR
Practice Address - Street 2:
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92618-4658
Practice Address - Country:US
Practice Address - Phone:949-540-5641
Practice Address - Fax:949-540-5642
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-08
Last Update Date:2023-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT21306225100000X
261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAP00197420OtherRAILROAD MEDICARE
CAPT0213060Medicaid
CAZZZ69559ZOtherBLUE SHIELD
CAZZZ69559ZOtherBLUE SHIELD