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General NPI Number Information
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NPI Number | 1023576147
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Entity Type | Individual
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Provider Name | EMMA LYNN KOSBAB
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Gender | Female
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Dates
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Enumeration Date | 03/07/2019
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Last Update Date | 02/02/2026
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Provider Practice Location Address
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Address Line | 5920 SANDY FORKS RD STE 200
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City | RALEIGH
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State | NC
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Zip | 27609-3814
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Country | US
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Telephone | 919-954-3174
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Fax |
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Provider Business Mailing Address
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Address Line | 500 SAINT ALBANS DR UNIT 237
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City | RALEIGH
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State | NC
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Zip | 27609-6667
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Country | US
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Telephone | 435-230-5622
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2251S0007X
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Taxonomy Name | Sports Physical Therapist
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License Number | P23209
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License Number State | NC
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Taxonomy #2
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Taxonomy Code | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number |
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License Number State |
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