Provider Demographics
NPI:1215172358
Name:KOTH, CHRISTINE A (MPT)
Entity type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:A
Last Name:KOTH
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:CHRISTINE
Other - Middle Name:A
Other - Last Name:MISORA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MPT
Mailing Address - Street 1:4139 WINDMILL LN
Mailing Address - Street 2:
Mailing Address - City:JANESVILLE
Mailing Address - State:WI
Mailing Address - Zip Code:53546-4206
Mailing Address - Country:US
Mailing Address - Phone:608-359-1737
Mailing Address - Fax:
Practice Address - Street 1:4539 WOODGATE DR
Practice Address - Street 2:
Practice Address - City:JANESVILLE
Practice Address - State:WI
Practice Address - Zip Code:53546-8205
Practice Address - Country:US
Practice Address - Phone:608-359-1737
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-03
Last Update Date:2008-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI6430-024225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist