Provider Demographics
NPI:1598530404
Name:JACOB, KOCHURANI (PT)
Entity Type:Individual
Prefix:
First Name:KOCHURANI
Middle Name:
Last Name:JACOB
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:523 ARGYLE RD
Mailing Address - Street 2:
Mailing Address - City:MINEOLA
Mailing Address - State:NY
Mailing Address - Zip Code:11501-1017
Mailing Address - Country:US
Mailing Address - Phone:516-471-0899
Mailing Address - Fax:
Practice Address - Street 1:337 JERUSALEM AVE
Practice Address - Street 2:
Practice Address - City:HICKSVILLE
Practice Address - State:NY
Practice Address - Zip Code:11801-5522
Practice Address - Country:US
Practice Address - Phone:516-324-3480
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-11-20
Last Update Date:2023-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY051571225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist