MEDICARE: JAMIE KOSCH MIKOLAY 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
1	225100000X	Physical Therapist	007023	CT

General Provider Information

NPI Number	:	1598892440
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JAMIE KOSCH MIKOLAY PT

Provider Business Mailing Address
First Line	:	105 WINTHROP RD
Second Line	:
City	:	GUILFORD
State	:	CT
Zip	:	06437-1632
Country	:	US
Telephone Number	:	203-453-1535
Fax Number	:

Provider Business Practice Location Address
First Line	:	2351 BOSTON POST ROAD
Second Line	:	SUITE 204
City	:	GUILFORD
State	:	CT
Zip	:	06437-4360
Country	:	US
Telephone Number	:	203-453-4321
Fax Number	:	203-453-4322

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

Provider Enumeration Date	:	02/27/2007
Last Update Date	:	07/08/2007

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Directions to “ JAMIE KOSCH MIKOLAY PT” Practice Location

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