Provider Demographics
NPI:1891991709
Name:KOCH, LUCY MARTINA (PTA)
Entity Type:Individual
Prefix:
First Name:LUCY
Middle Name:MARTINA
Last Name:KOCH
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1134 WINDMILL PALM
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78216-8006
Mailing Address - Country:US
Mailing Address - Phone:210-889-7853
Mailing Address - Fax:
Practice Address - Street 1:8634 FREDERICKSBURG RD
Practice Address - Street 2:SUITE NUMBER 212
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78254
Practice Address - Country:US
Practice Address - Phone:210-696-5777
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2053389225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant