Basic Information
| Provider Information | |||||||||
| NPI: | 1659338515 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | KOCH | ||||||||
| FirstName: | JENNIFER | ||||||||
| MiddleName: | B | ||||||||
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| Credential: | PT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3 HILL TER | ||||||||
| Address2: | |||||||||
| City: | NEWTON | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 078605162 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 13A MAIN ST | ||||||||
| Address2: | SUITE 4 | ||||||||
| City: | SPARTA | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 078711921 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9737267400 | ||||||||
| FaxNumber: | 9737267440 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/26/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | X | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 40QA00392500 | NJ | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.