Provider Demographics
NPI:1780209916
Name:KOCH, TROY JARED
Entity Type:Individual
Prefix:
First Name:TROY
Middle Name:JARED
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 1:1225 FOX RD
Mailing Address - Street 2:
Mailing Address - City:LEESPORT
Mailing Address - State:PA
Mailing Address - Zip Code:19533-8848
Mailing Address - Country:US
Mailing Address - Phone:610-463-5236
Mailing Address - Fax:
Practice Address - Street 1:425 NEW LONDON RD
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:DE
Practice Address - Zip Code:19711-7009
Practice Address - Country:US
Practice Address - Phone:302-453-1588
Practice Address - Fax:302-453-9970
Is Sole Proprietor?:No
Enumeration Date:2020-06-12
Last Update Date:2023-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT028709225100000X
PATPT023340225100000X
DEJ10014624225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist