Provider Demographics
NPI:1235119926
Name:KOSLOW, PERRY (PT)
Entity Type:Individual
Prefix:
First Name:PERRY
Middle Name:
Last Name:KOSLOW
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:350 NEW FIDELITY CT
Mailing Address - Street 2:
Mailing Address - City:GARNER
Mailing Address - State:NC
Mailing Address - Zip Code:27529-2665
Mailing Address - Country:US
Mailing Address - Phone:919-258-2714
Mailing Address - Fax:570-265-7422
Practice Address - Street 1:330 N MAIN ST
Practice Address - Street 2:SUITE 202
Practice Address - City:MOSCOW
Practice Address - State:PA
Practice Address - Zip Code:18444-9003
Practice Address - Country:US
Practice Address - Phone:570-842-8191
Practice Address - Fax:570-842-8192
Is Sole Proprietor?:No
Enumeration Date:2006-01-19
Last Update Date:2020-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT015184225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0001844881Medicaid
PA0001844881Medicaid