Provider Demographics
NPI:1548454473
Name:KOCH, VICTORIA AVC (MPH, PT)
Entity type:Individual
Prefix:MRS
First Name:VICTORIA
Middle Name:AVC
Last Name:KOCH
Suffix:
Gender:F
Credentials:MPH, PT
Other - Prefix:MS
Other - First Name:VICTORIA
Other - Middle Name:ANNE
Other - Last Name:VAN CULIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MPH, PT
Mailing Address - Street 1:11586 SOUTH LONGVIEW STREET
Mailing Address - Street 2:
Mailing Address - City:OLATHE
Mailing Address - State:KS
Mailing Address - Zip Code:66061-5678
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:10300 W 103RD ST
Practice Address - Street 2:SUITE 300
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66214-2642
Practice Address - Country:US
Practice Address - Phone:913-894-1910
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-09-04
Last Update Date:2007-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS11-02292225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS11-02292OtherSTATE LICENSE