Healthcare Provider Details

I. General information

NPI: 1922204288
Provider Name (Legal Business Name): NICHOLAS ALLEN COSGRAY M.S., PT, ATC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/25/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 PAUL BROWN STADIUM
CINCINNATI OH
45202-3418
US

IV. Provider business mailing address

1 PAUL BROWN STADIUM
CINCINNATI OH
45202-3418
US

V. Phone/Fax

Practice location:
  • Phone: 513-455-8471
  • Fax: 513-455-8477
Mailing address:
  • Phone: 513-455-8471
  • Fax: 513-455-8477

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251S0007X
TaxonomySports Physical Therapist
License NumberPT.011552
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: