Provider Demographics
NPI:1235935065
Name:KOCH, ANTHONY (HHP)
Entity type:Individual
Prefix:
First Name:ANTHONY
Middle Name:
Last Name:KOCH
Suffix:
Gender:
Credentials:HHP
Other - Prefix:
Other - First Name:ANDY
Other - Middle Name:
Other - Last Name:KOCH
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1524 MCCLELLAN DR
Mailing Address - Street 2:
Mailing Address - City:KLAMATH FALLS
Mailing Address - State:OR
Mailing Address - Zip Code:97603-4146
Mailing Address - Country:US
Mailing Address - Phone:541-591-5968
Mailing Address - Fax:
Practice Address - Street 1:2650 WASHBURN WAY UNIT 260
Practice Address - Street 2:
Practice Address - City:KLAMATH FALLS
Practice Address - State:OR
Practice Address - Zip Code:97603-4591
Practice Address - Country:US
Practice Address - Phone:541-591-5968
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-21
Last Update Date:2025-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR26687172M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172M00000XOther Service ProvidersMechanotherapist