Provider Demographics
NPI:1225182108
Name:KOSAKOWSKI, HEIDI A (MPT, COMT)
Entity Type:Individual
Prefix:MS
First Name:HEIDI
Middle Name:A
Last Name:KOSAKOWSKI
Suffix:
Gender:F
Credentials:MPT, COMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2031 P ST. NW
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20037
Mailing Address - Country:US
Mailing Address - Phone:202-331-1790
Mailing Address - Fax:202-331-1792
Practice Address - Street 1:2031 P ST. NW
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20037
Practice Address - Country:US
Practice Address - Phone:202-331-1790
Practice Address - Fax:202-331-1792
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-22
Last Update Date:2008-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT29803225100000X
DCPT8707882251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA056674Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER