Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 226300000X | Kinesiotherapist |
NPI | 1629264841 |
---|---|
Provider Name | Mrs. Nicole Laroux Cosby |
First Address | Charlottesville, VA 22903-2508 |
Second Address | San Diego, CA 92106-2810 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/09/2007 |
Last Update Date | 01/10/2020 |