Individual provider Active NPI

David J Koehn, PT

  • Physical Therapist
  • Walpole, MA
National Provider Identifier
1518956069
Registry record updated May 30, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
16688 Issued in MA
Practice address
1333 Main St
Suite G
Walpole, MA 02081-1755
Phone
(508) 668-8900
Fax
(508) 668-8901
NPI assigned
Oct 18, 2005
Last updated
May 30, 2012By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 30, 2012

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 16688 MA Primary

Addresses

Primary practice location

1333 Main St
Suite G
Walpole, MA 02081-1755

Mailing address

1333 Main St
Suite G
Walpole, MA 02081-1755
Phone (508) 668-8900

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20040202000102 MA Practitioner - Physical Therapist in Private Practice 2567365927 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
16688MAMDPhysical Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Boston Physical Therapy & Wellness, Inc Physical Therapist CurrentSince Dec 1, 2014 Accepting new patients
Motion Works Physical Therapy, LLC Physical Therapist PastSince Dec 21, 2016 Accepting new patients

Locations

275 Mystic Ave
Ste C
Medford, MA 02155
Phone (781) 572-2965

Organizations & group practices 2

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

NPI Registry JSON

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

{
    "created_epoch": "1129593600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1338336000000",
    "number": "1518956069",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1333 MAIN ST",
            "address_2": "SUITE G",
            "city": "WALPOLE",
            "state": "MA",
            "postal_code": "020811755",
            "telephone_number": "508-668-8900",
            "fax_number": "508-668-8901"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1333 MAIN ST",
            "address_2": "SUITE G",
            "city": "WALPOLE",
            "state": "MA",
            "postal_code": "020811755",
            "telephone_number": "508-668-8900",
            "fax_number": "508-668-8901"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KOEHN",
        "first_name": "DAVID",
        "middle_name": "J",
        "credential": "PT",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-10-18",
        "last_updated": "2012-05-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "MA",
            "license": "16688",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Walpole, MA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 30, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.