Individual
NATHAN DAVID KOCH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PTA
Contact information
Practice address
1601 ACADEMY RD, PONCA CITY, OK 74604-4409
(580) 760-0927
Mailing address
2505 WOODTHRUSH RD, PONCA CITY, OK 74604-2834
(918) 805-9042
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
2131
OK
Other
Enumeration date
06/14/2013
Last updated
06/14/2013
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