Provider Demographics
NPI:1780867168
Name:COSBY, BRAXTON (DPT)
Entity Type:Individual
Prefix:
First Name:BRAXTON
Middle Name:
Last Name:COSBY
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 1:1371 RIVER STATION DR
Mailing Address - Street 2:
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30045-2749
Mailing Address - Country:US
Mailing Address - Phone:404-304-0626
Mailing Address - Fax:678-894-0342
Practice Address - Street 1:1371 RIVER STATION DR
Practice Address - Street 2:
Practice Address - City:LAWRENCEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30045-2749
Practice Address - Country:US
Practice Address - Phone:404-304-0626
Practice Address - Fax:678-894-0342
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-09
Last Update Date:2020-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPT0078842251P0200X, 225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
No2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatricsGroup - Single Specialty