Individual provider Active NPI

Koby Markko Jansen, PT, DPT

  • Physical Therapist
  • Chandler, AZ
National Provider Identifier
1073377685
Registry record updated Jul 21, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
Practice address
375 E Elliot Rd
Chandler, AZ 85225-1129
Phone
(480) 912-6400
NPI assigned
Feb 13, 2024
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 21, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapist 225100000X Primary

Addresses

Primary practice location

375 E Elliot Rd
Chandler, AZ 85225-1129

Mailing address

22764 E Lords Way
Queen Creek, AZ 85142-0705
Phone (956) 609-1197

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AZ

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20250331000505 AZ Practitioner - Physical Therapist in Private Practice 1557703204 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physical Therapist in Private Practice
Education
Other, 2023
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Move Human Performance and Physical TherapyGroup PAC ID 6204247125, 2 clinicians

Practice addresses (Care Compare)

375 E Elliot Rd
Suite 7
Chandler, AZ 85225-1122
Phone (480) 912-6400

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
052185NYMDGeneral Practice Dentistry

Practice roles

OrganizationSpecialtyStatusNew patients
Move Human Performance and Physical Therapy CurrentSince Mar 3, 2025 Accepting new patients

Locations

375 E Elliot Rd
Ste 7
Chandler, AZ 85225
Phone (480) 516-5815

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1707782400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1753056000000",
    "number": "1073377685",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "22764 E LORDS WAY",
            "city": "QUEEN CREEK",
            "state": "AZ",
            "postal_code": "851420705",
            "telephone_number": "956-609-1197"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "375 E ELLIOT RD",
            "city": "CHANDLER",
            "state": "AZ",
            "postal_code": "852251129",
            "telephone_number": "480-912-6400"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JANSEN",
        "first_name": "KOBY",
        "middle_name": "MARKKO",
        "credential": "PT, DPT",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2024-02-13",
        "last_updated": "2025-07-21",
        "certification_date": "2025-07-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Chandler, AZ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.