Michael R. Koch, PT

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

4135-024 Issued in WI

Practice address

1948 Godfrey Dr
Waupaca, WI 54981-7908

Phone

(715) 340-5383

Fax

(715) 258-7773

NPI assigned

Jul 19, 2006

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

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in WI

Enrollment records 1

Specialty

Physical Therapist in Private Practice

Education

Other, 1991

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Spine and Sport Physical Therapy of Waupaca LLCGroup PAC ID 5395821151, 3 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

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.

• Spine and Sport Physical Therapy of Waupaca LLC

  • Physical Therapist
  • Waupaca, WI
  • NPI 1770768046
  Medicare reassignment Care Compare group NPD Authorized official

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

{
    "created_epoch": "1153267200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1539216000000",
    "number": "1225058878",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1439 CHURCHILL ST",
            "address_2": "SUITE 102",
            "city": "WAUPACA",
            "state": "WI",
            "postal_code": "549812089",
            "telephone_number": "715-258-7778",
            "fax_number": "715-258-7773"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1948 GODFREY DR",
            "city": "WAUPACA",
            "state": "WI",
            "postal_code": "549817908",
            "telephone_number": "715-340-5383",
            "fax_number": "715-258-7773"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KOCH",
        "first_name": "MICHAEL",
        "middle_name": "R.",
        "credential": "PT",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-07-19",
        "last_updated": "2018-10-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "WI",
            "license": "4135-024",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "40224600",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Patty Kile
• Bradley Klein, APNP
• Joy Kobiske, NP
• Koch Chiropractic and Wellness Center
• Gina M. Koch, D.C.
• Zachary Donald Koepke, DPT
• Jessica Kossel, M.S., CCC-SLP
• Kimberly Marie Kraeger, LCSW
• Deborah Kraemer
• Cari Jo Kramer, AUD

• Physical Therapist in Waupaca, WI
• Providers in Waupaca, WI by specialty
• Physical Therapist in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 11, 2018; 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.