MEDICARE: KOSIK ENTERPRISE, LLC

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	261QP2000X	Physical Therapy Clinic/Center

General Provider Information

NPI Number	:	1063193415
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KOSIK ENTERPRISE, LLC

Provider Business Mailing Address
First Line	:	10031 GRAND CANAL DR UNIT 18302
Second Line	:
City	:	WINDERMERE
State	:	FL
Zip	:	34786-5861
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1620 DANIELS RD STE 130
Second Line	:
City	:	WINTER GARDEN
State	:	FL
Zip	:	34787-5604
Country	:	US
Telephone Number	:	570-332-4924
Fax Number	:

Authorized Official
Title or Position	:	PT AND OWNER
Name	:	SYDNEY LEAH KOSIK
Credential	:	PT, DPT
Telephone Number	:	570-332-4924

Provider Enumeration Date	:	07/28/2023
Last Update Date	:	08/01/2023

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Directions to “KOSIK ENTERPRISE, LLC ” Practice Location

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