Healthcare Provider Details

I. General information

NPI: 1457431975
Provider Name (Legal Business Name): ALEX M KOSZALINSKI DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/17/2006
Last Update Date: 10/22/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1712 OWEN DR
FAYETTEVILLE NC
28304-3419
US

IV. Provider business mailing address

1910 N CHURCH ST STE D
GREENSBORO NC
27405-5632
US

V. Phone/Fax

Practice location:
  • Phone: 910-483-9300
  • Fax: 910-483-9302
Mailing address:
  • Phone: 336-274-7480
  • Fax: 336-274-8903

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT-007414
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number11380
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: