Provider Demographics
NPI:1861945156
Name:KOCAN, JUSTIN RN (DPT)
Entity type:Individual
Prefix:
First Name:JUSTIN
Middle Name:RN
Last Name:KOCAN
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2826 RANDOLPH RD
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28211-1386
Mailing Address - Country:US
Mailing Address - Phone:704-366-5521
Mailing Address - Fax:704-364-3953
Practice Address - Street 1:2826 RANDOLPH RD
Practice Address - Street 2:2ND FLOOR
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28211-1386
Practice Address - Country:US
Practice Address - Phone:704-366-5521
Practice Address - Fax:704-364-3953
Is Sole Proprietor?:No
Enumeration Date:2016-08-03
Last Update Date:2019-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC164892251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
343569Medicare PIN