Provider Demographics
NPI:1982983045
Name:KOECK, JENA (PT)
Entity type:Individual
Prefix:
First Name:JENA
Middle Name:
Last Name:KOECK
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:JENA
Other - Middle Name:
Other - Last Name:PETERKA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1311 WAKARUSA DR
Mailing Address - Street 2:SUITE 1000
Mailing Address - City:LAWRENCE
Mailing Address - State:KS
Mailing Address - Zip Code:66049-4798
Mailing Address - Country:US
Mailing Address - Phone:785-749-1300
Mailing Address - Fax:785-749-4946
Practice Address - Street 1:1311 WAKARUSA DR
Practice Address - Street 2:SUITE 1000
Practice Address - City:LAWRENCE
Practice Address - State:KS
Practice Address - Zip Code:66049-4798
Practice Address - Country:US
Practice Address - Phone:785-749-1300
Practice Address - Fax:785-749-4946
Is Sole Proprietor?:No
Enumeration Date:2011-08-08
Last Update Date:2011-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS11-04313225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist