Provider Demographics
NPI:1568858835
Name:KOCCHI, AUSTIN (DPT)
Entity Type:Individual
Prefix:
First Name:AUSTIN
Middle Name:
Last Name:KOCCHI
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:PO BOX 4570
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85261-4570
Mailing Address - Country:US
Mailing Address - Phone:480-551-4961
Mailing Address - Fax:
Practice Address - Street 1:16838 E PALISADES BLVD
Practice Address - Street 2:BLDG B-121
Practice Address - City:FOUNTAIN HILLS
Practice Address - State:AZ
Practice Address - Zip Code:85268-3786
Practice Address - Country:US
Practice Address - Phone:480-837-2595
Practice Address - Fax:480-837-2773
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-13
Last Update Date:2015-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ11360225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist