Zachary Koba, PTA

Primary specialty

Physical Therapy AssistantTaxonomy code 225200000X

License

2207-19 Issued in WI

Practice address

10930 W Potter Rd Ste C
Wauwatosa, WI 53226-3450

Phone

(414) 522-9000

NPI assigned

Jul 22, 2021

Sex

Male

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)

Not enrolled

State licenses

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

{
    "created_epoch": "1626912000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1637625600000",
    "number": "1891368270",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "33900 HARPER AVE STE 104",
            "city": "CLINTON TWP",
            "state": "MI",
            "postal_code": "480354258",
            "telephone_number": "586-350-2644"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10930 W POTTER RD STE C",
            "city": "WAUWATOSA",
            "state": "WI",
            "postal_code": "532263450",
            "telephone_number": "414-522-9000"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "813 N Mayfair Rd",
            "address_purpose": "LOCATION",
            "city": "Wauwatosa",
            "state": "WI",
            "postal_code": "532264241",
            "country_code": "US",
            "telephone_number": "414-522-9000",
            "fax_number": "414-522-9007",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "KOBA",
        "first_name": "ZACHARY",
        "credential": "PTA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2021-07-22",
        "last_updated": "2021-11-23",
        "certification_date": "2021-11-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225200000X",
            "taxonomy_group": "",
            "desc": "Physical Therapy Assistant",
            "state": "WI",
            "license": "2207-19",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Richard V. Knoff, D.D.S.
• Tori Rose Knueppel, LPC-IT
• Chad Knutson, RD
• Keith Knutson
• Kristen Knutson
• Julie Anne Koch, M.S.
• Matthew Joseph Koch, DPT
• Rachael Koch
• Rajiv Kodali, MD
• Mellisa Yu Koenings, PA-C

• Physical Therapy Assistant in Wauwatosa, WI
• Providers in Wauwatosa, WI by specialty
• Physical Therapy Assistant in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 23, 2021; 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.