MEDICARE: STACY ANN KOSCINSKI MSPT

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	2251N0400X	Neurology Physical Therapist	1144210	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1144210	OTHER	TX	LICENSE
2	1046077	OTHER	TX	BLUE LINK NUMBER

General Provider Information

NPI Number	:	1174576128
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STACY ANN KOSCINSKI MSPT

Provider Business Mailing Address
First Line	:	12727 KIMBERLEY LN
Second Line	:	STE 103
City	:	HOUSTON
State	:	TX
Zip	:	77024-4047
Country	:	US
Telephone Number	:	713-365-9338
Fax Number	:

Provider Business Practice Location Address
First Line	:	4009 BELLAIRE BLVD
Second Line	:	SUITE M
City	:	HOUSTON
State	:	TX
Zip	:	77025-1168
Country	:	US
Telephone Number	:	713-669-0042
Fax Number	:

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

Provider Enumeration Date	:	05/19/2006
Last Update Date	:	12/09/2016

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