Provider Demographics
NPI:1154446045
Name:KOTCH, JOSEPH RICHARD JR (MPT)
Entity Type:Individual
Prefix:MR
First Name:JOSEPH
Middle Name:RICHARD
Last Name:KOTCH
Suffix:JR
Gender:M
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:50 CARRIEGA HOUSE LANE
Mailing Address - Street 2:APT #2
Mailing Address - City:REEDSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:17084-9650
Mailing Address - Country:US
Mailing Address - Phone:717-667-3490
Mailing Address - Fax:
Practice Address - Street 1:4702 E MAIN ST
Practice Address - Street 2:
Practice Address - City:BELLEVILLE
Practice Address - State:PA
Practice Address - Zip Code:17004-9299
Practice Address - Country:US
Practice Address - Phone:717-935-2105
Practice Address - Fax:717-935-5109
Is Sole Proprietor?:No
Enumeration Date:2007-03-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT005942L225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0007565600002Medicaid
PA606800OtherHIGHMARK
PA01986001OtherCAPITOL BLUE CROSS
PA0007565600002Medicaid