Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225200000X | Physical Therapy Assistant | PTA.0014941 | CO |
NPI | 1003560012 |
---|---|
Provider Name | Immaculate Jemaiyo Kosgei |
First Address | Colorado Springs, CO 80925-1184 |
Second Address | Colorado Springs, CO 80925-1184 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/02/2022 |
Last Update Date | 08/02/2022 |