Mahtab Koochaki, PT, DPT

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

5501019028 Issued in MI

Practice address

261 Mack Ave
Detroit, MI 48201-2417

Phone

(313) 745-1100

Fax

(313) 745-0476

NPI assigned

Feb 20, 2019

Sex

Female

Sole proprietor

No

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)

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.

• Rehab and Recovery PT

  • Physical Therapist
  • Houston, TX
  • NPI 1417795279
  NPD Authorized official
• Powerback Rehabilitation LLC

  • Physical Therapist
  • North Richland Hills, TX
  • NPI 1427454164
  NPD
• Powerback Rehabilitation LLC

  • Physical Therapist
  • Woodbridge, VA
  • NPI 1790640761
  NPD

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

{
    "created_epoch": "1550620800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1550620800000",
    "number": "1720545262",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "29131 CREEK BEND DR",
            "city": "FARMINGTON HILLS",
            "state": "MI",
            "postal_code": "483312607"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "261 MACK AVE",
            "city": "DETROIT",
            "state": "MI",
            "postal_code": "482012417",
            "telephone_number": "313-745-1100",
            "fax_number": "313-745-0476"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "29131 Creek Bend Dr",
            "address_purpose": "LOCATION",
            "city": "Farmington Hills",
            "state": "MI",
            "postal_code": "483312607",
            "country_code": "US",
            "telephone_number": "248-943-9105",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "KOOCHAKI",
        "first_name": "MAHTAB",
        "credential": "PT, DPT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-02-20",
        "last_updated": "2019-02-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "MI",
            "license": "5501019028",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Katherine Elizabeth Konrad, NP
• Laura Dorothy Konsitzke, PA-C
• Danica Kontic
• Natalie Renee Kontos, DO
• Kathleen June Konwiak, LLP
• Breanna Kooienga
• Beverly A Koonce
• Jasmeet Kaur Kooner
• Kristine Koos, LLMSW
• Danielle Anne Koppert, NP

• Physical Therapist in Detroit, MI
• Providers in Detroit, MI by specialty
• Physical Therapist in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 20, 2019; 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.