Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251N0400X | Physical Therapist - Neurology | 1144210 | TX |
NPI | 1174576128 |
---|---|
Provider Name | Stacy Ann Koscinski |
First Address | Houston, TX 77024-4047 |
Second Address | Houston, TX 77025-1168 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/05/2006 |
Last Update Date | 09/12/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1046077 | BLUE LINK NUMBER (01) | TX |
1144210 | LICENSE (01) | TX |