Provider Demographics
NPI:1154460665
Name:KOCH, PHILIP J (PT)
Entity Type:Individual
Prefix:MR
First Name:PHILIP
Middle Name:J
Last Name:KOCH
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:31 STONYWOOD DR
Mailing Address - Street 2:
Mailing Address - City:COMMACK
Mailing Address - State:NY
Mailing Address - Zip Code:11725-5111
Mailing Address - Country:US
Mailing Address - Phone:631-543-0549
Mailing Address - Fax:
Practice Address - Street 1:99 TULIP AVE
Practice Address - Street 2:SUITE 407
Practice Address - City:FLORAL PARK
Practice Address - State:NY
Practice Address - Zip Code:11001-1974
Practice Address - Country:US
Practice Address - Phone:516-358-9146
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY006167225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist