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General NPI Number Information
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NPI Number | 1689219776
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Entity Type | Individual
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Provider Name | MATTHEW KOSAR DPT
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Gender | Male
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Dates
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Enumeration Date | 11/12/2019
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Last Update Date | 11/12/2019
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Provider Practice Location Address
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Address Line | 1251 TURNSTONE DR
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City | FOGELSVILLE
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State | PA
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Zip | 18051-1713
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Country | US
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Telephone | 484-822-5152
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Fax |
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Provider Business Mailing Address
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Address Line | 5750 BUCKINGHAM CT
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City | LAURYS STATION
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State | PA
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Zip | 18059-1001
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Country | US
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Telephone | 610-417-7112
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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 | PT026641
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License Number State | PA
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