Provider Demographics
NPI:1598892440
Name:MIKOLAY, JAMIE KOSCH (PT)
Entity Type:Individual
Prefix:
First Name:JAMIE
Middle Name:KOSCH
Last Name:MIKOLAY
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:105 WINTHROP RD
Mailing Address - Street 2:
Mailing Address - City:GUILFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06437-1632
Mailing Address - Country:US
Mailing Address - Phone:203-453-1535
Mailing Address - Fax:
Practice Address - Street 1:2351 BOSTON POST ROAD
Practice Address - Street 2:SUITE 204
Practice Address - City:GUILFORD
Practice Address - State:CT
Practice Address - Zip Code:06437-4360
Practice Address - Country:US
Practice Address - Phone:203-453-4321
Practice Address - Fax:203-453-4322
Is Sole Proprietor?:No
Enumeration Date:2007-02-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT007023225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist