Provider Demographics
NPI:1215103080
Name:AMIN, KOKI K (DPT)
Entity type:Individual
Prefix:
First Name:KOKI
Middle Name:K
Last Name:AMIN
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:643 W SAN CARLOS WAY
Mailing Address - Street 2:
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85248
Mailing Address - Country:US
Mailing Address - Phone:480-882-0766
Mailing Address - Fax:480-374-5287
Practice Address - Street 1:643 W SAN CARLOS WAY
Practice Address - Street 2:
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85248-5173
Practice Address - Country:US
Practice Address - Phone:480-882-0766
Practice Address - Fax:480-374-5287
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-01
Last Update Date:2017-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ8041174400000X, 225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty