MEDICARE: EMMA LYNN KOSBAB

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2251S0007X	Sports Physical Therapist	P23209	NC
2	2255A2300X	Athletic Trainer

General Provider Information

NPI Number	:	1023576147
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EMMA LYNN KOSBAB

Provider Business Mailing Address
First Line	:	500 SAINT ALBANS DR UNIT 237
Second Line	:
City	:	RALEIGH
State	:	NC
Zip	:	27609-6667
Country	:	US
Telephone Number	:	435-230-5622
Fax Number	:

Provider Business Practice Location Address
First Line	:	5920 SANDY FORKS RD STE 200
Second Line	:
City	:	RALEIGH
State	:	NC
Zip	:	27609-3814
Country	:	US
Telephone Number	:	919-954-3174
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/07/2019
Last Update Date	:	02/02/2026

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Directions to “ EMMA LYNN KOSBAB ” Practice Location

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