Glen Wayne Koch, LMT

Primary specialty

Massage TherapistTaxonomy code 225700000X

License

MA60133166 Issued in WA

Practice address

2552 S Discovery Rd
Port Townsend, WA 98368-8216

Phone

(360) 316-9093

NPI assigned

Feb 4, 2010

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1265241600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1731542400000",
    "number": "1194057893",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2552 S DISCOVERY RD",
            "city": "PORT TOWNSEND",
            "state": "WA",
            "postal_code": "983688216",
            "telephone_number": "360-316-9093"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2552 S DISCOVERY RD",
            "city": "PORT TOWNSEND",
            "state": "WA",
            "postal_code": "983688216",
            "telephone_number": "360-316-9093"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3019 Eddy St",
            "address_purpose": "LOCATION",
            "city": "Port Townsend",
            "state": "WA",
            "postal_code": "983685919",
            "country_code": "US",
            "telephone_number": "360-316-9093",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "KOCH",
        "first_name": "GLEN",
        "middle_name": "WAYNE",
        "name_prefix": "Mr.",
        "credential": "LMT",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2010-02-04",
        "last_updated": "2024-11-14",
        "certification_date": "2024-11-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225700000X",
            "taxonomy_group": "",
            "desc": "Massage Therapist",
            "state": "WA",
            "license": "MA60133166",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Sarah Elizabeth Kirkegaard, MSN, ARNP
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• Joshua Kraetsch, LMHC
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• Marta Lee Krissovich, ANP-BC, CWOCN-AP
• Vanessa D Kroger, MA

• Massage Therapist in Port Townsend, WA
• Providers in Port Townsend, WA by specialty
• Massage Therapist in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 14, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.