Provider Demographics
NPI:1053364711
Name:KOCHANSKI, MARK (PT)
Entity type:Individual
Prefix:
First Name:MARK
Middle Name:
Last Name:KOCHANSKI
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8823 PRODUCTION LN
Mailing Address - Street 2:
Mailing Address - City:OOLTEWAH
Mailing Address - State:TN
Mailing Address - Zip Code:37363-6511
Mailing Address - Country:US
Mailing Address - Phone:423-238-7217
Mailing Address - Fax:423-238-3473
Practice Address - Street 1:7380 VOLKSWAGEN DR
Practice Address - Street 2:STE 190A
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37416-1755
Practice Address - Country:US
Practice Address - Phone:423-933-1672
Practice Address - Fax:423-933-1675
Is Sole Proprietor?:No
Enumeration Date:2006-05-17
Last Update Date:2014-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN0446652Medicaid
TN3156797OtherBCBS - GROUP NUMBER
TN0446652Medicaid