Provider Demographics
NPI:1750884433
Name:KOCH, KATHERINE (PT, DPT, OMPT)
Entity type:Individual
Prefix:
First Name:KATHERINE
Middle Name:
Last Name:KOCH
Suffix:
Gender:F
Credentials:PT, DPT, OMPT
Other - Prefix:
Other - First Name:KATHERINE
Other - Middle Name:
Other - Last Name:MOY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT, DPT
Mailing Address - Street 1:54945 MOUND RD
Mailing Address - Street 2:
Mailing Address - City:SHELBY TOWNSHIP
Mailing Address - State:MI
Mailing Address - Zip Code:48316-6028
Mailing Address - Country:US
Mailing Address - Phone:586-992-1500
Mailing Address - Fax:586-992-8050
Practice Address - Street 1:54945 MOUND RD
Practice Address - Street 2:
Practice Address - City:SHELBY TOWNSHIP
Practice Address - State:MI
Practice Address - Zip Code:48316-6028
Practice Address - Country:US
Practice Address - Phone:586-992-1500
Practice Address - Fax:586-992-8050
Is Sole Proprietor?:No
Enumeration Date:2018-03-09
Last Update Date:2021-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI55010185882251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic