Individual
MICHAEL R. KOCH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PT
Contact information
Practice address
1948 GODFREY DR, WAUPACA, WI 54981-7908
(715) 340-5383
(715) 258-7773
Mailing address
1439 CHURCHILL ST, SUITE 102, WAUPACA, WI 54981-2089
(715) 258-7778
(715) 258-7773
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
4135-024
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
40224600
—
WI
Enumeration date
07/19/2006
Last updated
10/11/2018
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