Provider Demographics
NPI:1477679751
Name:KOCHMAN, CARRIE ALYSE (PT, MPT)
Entity Type:Individual
Prefix:MRS
First Name:CARRIE
Middle Name:ALYSE
Last Name:KOCHMAN
Suffix:
Gender:F
Credentials:PT, MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3 MAPLEWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:RUMSON
Mailing Address - State:NJ
Mailing Address - Zip Code:07760-1762
Mailing Address - Country:US
Mailing Address - Phone:732-614-8721
Mailing Address - Fax:
Practice Address - Street 1:2 KATHLEEN DR
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:NJ
Practice Address - Zip Code:08527-2269
Practice Address - Country:US
Practice Address - Phone:732-614-8721
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-21
Last Update Date:2020-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJNJQA00852300225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
020600SM5Medicare ID - Type Unspecified