Provider Demographics
NPI:1508229998
Name:NORTHLAND RURAL THERAPY ASSOCIATES
Entity Type:Organization
Organization Name:NORTHLAND RURAL THERAPY ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:
Authorized Official - Last Name:COSNER
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:928-779-1679
Mailing Address - Street 1:2224 E CEDAR AVE STE 1
Mailing Address - Street 2:
Mailing Address - City:FLAGSTAFF
Mailing Address - State:AZ
Mailing Address - Zip Code:86004-1957
Mailing Address - Country:US
Mailing Address - Phone:928-779-1679
Mailing Address - Fax:
Practice Address - Street 1:2224 E CEDAR AVE STE 1
Practice Address - Street 2:
Practice Address - City:FLAGSTAFF
Practice Address - State:AZ
Practice Address - Zip Code:86004-1957
Practice Address - Country:US
Practice Address - Phone:928-779-1679
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-04-01
Last Update Date:2016-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZSLP2202251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health