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General NPI Number Information
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NPI Number | 1093220691
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Entity Type | Individual
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Provider Name | NIBU KOSHY GEORGE RPT
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Gender | Male
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Dates
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Enumeration Date | 12/05/2017
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Last Update Date | 03/17/2018
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Provider Practice Location Address
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Address Line | 680 N WATTERS RD
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City | ALLEN
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State | TX
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Zip | 75013-5126
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Country | US
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Telephone | 596-744-9042
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Fax |
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Provider Business Mailing Address
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Address Line | 620 N COPPELL RD APT 4204
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City | COPPELL
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State | TX
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Zip | 75019-2055
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Country | US
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Telephone | 586-744-9042
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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 | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 1286050
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License Number State | TX
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