MEDICARE: JAMES H KOSTREWA PT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	4204	AZ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	11394042	OTHER	AZ	CAQH
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1679576698
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JAMES H KOSTREWA PT

Provider Business Mailing Address
First Line	:	7540 N 19TH AVE STE 101
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85021-7967
Country	:	US
Telephone Number	:	602-249-9129
Fax Number	:	602-249-4115

Provider Business Practice Location Address
First Line	:	7540 N 19TH AVE STE 101
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85021
Country	:	US
Telephone Number	:	602-249-9129
Fax Number	:	602-249-4115

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/23/2005
Last Update Date	:	07/13/2018

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