Provider Demographics
NPI:1508004334
Name:KOSMAN, JOAN LOUISE (PT)
Entity Type:Individual
Prefix:MRS
First Name:JOAN
Middle Name:LOUISE
Last Name:KOSMAN
Suffix:
Gender:F
Credentials:PT
Other - Prefix:MISS
Other - First Name:JOAN
Other - Middle Name:LOUISE
Other - Last Name:PETERSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:610 PETERSON RD
Mailing Address - Street 2:
Mailing Address - City:LIBERTYVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60048-1014
Mailing Address - Country:US
Mailing Address - Phone:847-367-6100
Mailing Address - Fax:
Practice Address - Street 1:610 PETERSON RD
Practice Address - Street 2:
Practice Address - City:LIBERTYVILLE
Practice Address - State:IL
Practice Address - Zip Code:60048-1014
Practice Address - Country:US
Practice Address - Phone:847-367-6100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-02-02
Last Update Date:2009-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070.001656225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist