Provider Demographics
NPI:1962706705
Name:KOCHER, DEREK LEWIS (PT, DPT)
Entity type:Individual
Prefix:DR
First Name:DEREK
Middle Name:LEWIS
Last Name:KOCHER
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3 SHERWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:WHEELING
Mailing Address - State:WV
Mailing Address - Zip Code:26003-5044
Mailing Address - Country:US
Mailing Address - Phone:304-771-8982
Mailing Address - Fax:
Practice Address - Street 1:1001 W BALTIMORE ST
Practice Address - Street 2:
Practice Address - City:MCMECHEN
Practice Address - State:WV
Practice Address - Zip Code:26040-1503
Practice Address - Country:US
Practice Address - Phone:304-242-4004
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-01-10
Last Update Date:2011-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV2802225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist