Provider Demographics
NPI:1326515958
Name:KOHUTKA, JOHN DYLAN (DPT)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:DYLAN
Last Name:KOHUTKA
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1524 DEKALB PIKE
Mailing Address - Street 2:
Mailing Address - City:BLUE BELL
Mailing Address - State:PA
Mailing Address - Zip Code:19422-3368
Mailing Address - Country:US
Mailing Address - Phone:610-275-0330
Mailing Address - Fax:
Practice Address - Street 1:1524 DEKALB PIKE
Practice Address - Street 2:
Practice Address - City:BLUE BELL
Practice Address - State:PA
Practice Address - Zip Code:19422-3368
Practice Address - Country:US
Practice Address - Phone:610-275-0330
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-11-01
Last Update Date:2021-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSPT6573225100000X
PAPT029093225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist