Provider Demographics
NPI:1689219776
Name:KOSAR, MATTHEW (DPT)
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:
Last Name:KOSAR
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5750 BUCKINGHAM CT
Mailing Address - Street 2:
Mailing Address - City:LAURYS STATION
Mailing Address - State:PA
Mailing Address - Zip Code:18059-1001
Mailing Address - Country:US
Mailing Address - Phone:610-417-7112
Mailing Address - Fax:
Practice Address - Street 1:1251 TURNSTONE DR
Practice Address - Street 2:
Practice Address - City:FOGELSVILLE
Practice Address - State:PA
Practice Address - Zip Code:18051-1713
Practice Address - Country:US
Practice Address - Phone:484-822-5152
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-11-12
Last Update Date:2019-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT026641225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist