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NPI Code Detail

MEDICARE: JUDITH ANN KOSKODAN PT

MEDICARE: JUDITH ANN KOSKODAN PT
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
1225100000XPhysical Therapist5501007048MI
2235Z00000XSpeech-Language Pathologist5501007048MI

General Provider Information

NPI Number : 1255576559
Entity Type Code : Individual
Provider Name (Legal Business Name) : JUDITH ANN KOSKODAN PT
Provider Business Mailing Address
First Line : 5314 BISHOP RD
Second Line :
City : DRYDEN
State : MI
Zip : 48428-9335
Country : US
Telephone Number : 810-796-3796
Fax Number :
Provider Business Practice Location Address
First Line : 122 S MAIN ST
Second Line :
City : ALMONT
State : MI
Zip : 48003-1066
Country : US
Telephone Number : 800-974-4378
Fax Number : 630-515-1536
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/16/2008
Last Update Date : 08/26/2021

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Directions to “ JUDITH ANN KOSKODAN PT” Practice Location

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