Healthcare Provider Details

I. General information

NPI: 1003023623
Provider Name (Legal Business Name): KATHLEEN ANN KOSOWSKY B.S., P.T.A.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/16/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1210 S OLD DIXIE HWY
JUPITER FL
33458-7205
US

IV. Provider business mailing address

19085 SE SOUTHGATE DR
TEQUESTA FL
33469-1677
US

V. Phone/Fax

Practice location:
  • Phone: 561-747-2234
  • Fax: 561-745-5747
Mailing address:
  • Phone: 561-575-9287
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License NumberPTA18753
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: