Provider Demographics
NPI:1215939087
Name:KOCH, STEPHEN JOSEPH (PT)
Entity type:Individual
Prefix:MR
First Name:STEPHEN
Middle Name:JOSEPH
Last Name:KOCH
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16 SHADY HOLLOW LN
Mailing Address - Street 2:
Mailing Address - City:SHILLINGTON
Mailing Address - State:PA
Mailing Address - Zip Code:19607-3003
Mailing Address - Country:US
Mailing Address - Phone:610-775-5369
Mailing Address - Fax:
Practice Address - Street 1:3909 PERKIOMEN AVE
Practice Address - Street 2:
Practice Address - City:READING
Practice Address - State:PA
Practice Address - Zip Code:19606-2718
Practice Address - Country:US
Practice Address - Phone:610-370-0070
Practice Address - Fax:610-370-0075
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-11
Last Update Date:2010-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT006390L225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA023940Medicare ID - Type Unspecified