Provider Demographics
NPI:1205861762
Name:KOCHEL, IRVIN III (PT)
Entity Type:Individual
Prefix:
First Name:IRVIN
Middle Name:
Last Name:KOCHEL
Suffix:III
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 1:4770 LUCERNE RD
Mailing Address - Street 2:
Mailing Address - City:INDIANA
Mailing Address - State:PA
Mailing Address - Zip Code:15701-6002
Mailing Address - Country:US
Mailing Address - Phone:724-840-5751
Mailing Address - Fax:724-801-8183
Practice Address - Street 1:4770 LUCERNE RD
Practice Address - Street 2:
Practice Address - City:INDIANA
Practice Address - State:PA
Practice Address - Zip Code:15701-6002
Practice Address - Country:US
Practice Address - Phone:724-840-5751
Practice Address - Fax:724-801-8183
Is Sole Proprietor?:No
Enumeration Date:2006-07-12
Last Update Date:2011-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT006074L225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA103700YDYLMedicare PIN
PA207604Medicare PIN