Provider Demographics
NPI:1659338515
Name:KOCH, JENNIFER B (PT)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:B
Last Name:KOCH
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 1:3 HILL TER
Mailing Address - Street 2:
Mailing Address - City:NEWTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07860-5162
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:13A MAIN ST
Practice Address - Street 2:SUITE 4
Practice Address - City:SPARTA
Practice Address - State:NJ
Practice Address - Zip Code:07871-1921
Practice Address - Country:US
Practice Address - Phone:973-726-7400
Practice Address - Fax:973-726-7440
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA00392500225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist