Provider Demographics
NPI:1982428702
Name:KOCH, HANNAH JIANKAN (PT, DPT)
Entity type:Individual
Prefix:DR
First Name:HANNAH
Middle Name:JIANKAN
Last Name:KOCH
Suffix:
Gender:F
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 1:1625 RADIO DR STE 220
Mailing Address - Street 2:
Mailing Address - City:WOODBURY
Mailing Address - State:MN
Mailing Address - Zip Code:55125-9476
Mailing Address - Country:US
Mailing Address - Phone:651-241-3632
Mailing Address - Fax:
Practice Address - Street 1:1625 RADIO DR STE 220
Practice Address - Street 2:
Practice Address - City:WOODBURY
Practice Address - State:MN
Practice Address - Zip Code:55125-9476
Practice Address - Country:US
Practice Address - Phone:651-241-3632
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-11-08
Last Update Date:2024-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN13465225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist