Provider Demographics
NPI:1417385915
Name:KOCH, AMY (PT, CMPT, COMT)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:
Last Name:KOCH
Suffix:
Gender:
Credentials:PT, CMPT, COMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 3755
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68103-0755
Mailing Address - Country:US
Mailing Address - Phone:402-354-2100
Mailing Address - Fax:402-354-2155
Practice Address - Street 1:11336 S 96TH ST STE 114
Practice Address - Street 2:
Practice Address - City:PAPILLION
Practice Address - State:NE
Practice Address - Zip Code:68046-4211
Practice Address - Country:US
Practice Address - Phone:402-315-3603
Practice Address - Fax:402-718-9973
Is Sole Proprietor?:No
Enumeration Date:2013-10-18
Last Update Date:2025-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE2511225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE10025895900Medicaid
NE10026056700Medicaid
IA1417385915Medicaid
NE10025896000Medicaid
NE10025896100Medicaid
NE10025941700Medicaid
NE10026252200Medicaid
NE10026445500Medicaid
IA1417385915Medicaid