Provider Demographics
NPI:1699180158
Name:KOCH, ERIK
Entity Type:Individual
Prefix:
First Name:ERIK
Middle Name:
Last Name:KOCH
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:331 MEADOW ST
Mailing Address - Street 2:
Mailing Address - City:FORD CITY
Mailing Address - State:PA
Mailing Address - Zip Code:16226-1637
Mailing Address - Country:US
Mailing Address - Phone:724-664-2340
Mailing Address - Fax:
Practice Address - Street 1:265 S MCKEAN ST
Practice Address - Street 2:
Practice Address - City:KITTANNING
Practice Address - State:PA
Practice Address - Zip Code:16201-1607
Practice Address - Country:US
Practice Address - Phone:724-548-2222
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-06-24
Last Update Date:2014-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TEI001529225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant