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General NPI Number Information
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NPI Number | 1861876096
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Entity Type | Individual
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Provider Name | GREGORY COSSAIRT DPT
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Gender | Male
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Dates
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Enumeration Date | 07/17/2015
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Last Update Date | 07/17/2015
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Provider Practice Location Address
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Address Line | 4621 HWY 59 N
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City | GROVE
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State | OK
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Zip | 74344
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Country | US
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Telephone | 918-787-3751
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Fax |
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Provider Business Mailing Address
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Address Line | 4261 HIGHWAY 59 NORTH
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City | GROVE
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State | OK
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Zip | 74344
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Country | US
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Telephone | 918-787-3751
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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 | 4480
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License Number State | OK
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