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General NPI Number Information
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NPI Number | 1477921906
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Entity Type | Individual
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Provider Name | SUSAN WARD KOSKO DPT
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Gender | Female
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Dates
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Enumeration Date | 09/15/2015
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Last Update Date | 09/15/2015
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Provider Practice Location Address
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Address Line | 207 W JACKSON ST
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City | RIDGELAND
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State | MS
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Zip | 39157-2355
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Country | US
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Telephone | 601-362-0859
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Fax |
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Provider Business Mailing Address
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Address Line | 246 LAKE CIR
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City | MADISON
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State | MS
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Zip | 39110-6303
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Country | US
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Telephone | 865-300-5149
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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 | PTH7184
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License Number State | AL
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Taxonomy #2
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Taxonomy Code | 2251P0200X
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Taxonomy Name | Pediatric Physical Therapist
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License Number | PTH7184
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License Number State | AL
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