Provider Demographics
NPI:1083943195
Name:MCCOSKEY, C. TERESA (LMT)
Entity Type:Individual
Prefix:MS
First Name:C. TERESA
Middle Name:
Last Name:MCCOSKEY
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10701 6TH ST N
Mailing Address - Street 2:
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34108-1806
Mailing Address - Country:US
Mailing Address - Phone:239-287-9196
Mailing Address - Fax:
Practice Address - Street 1:2180 IMMOKALEE RD
Practice Address - Street 2:SUITE 312
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34110-1421
Practice Address - Country:US
Practice Address - Phone:239-514-4351
Practice Address - Fax:206-203-1186
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-18
Last Update Date:2009-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA48902172M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172M00000XOther Service ProvidersMechanotherapist