Provider Demographics
NPI:1790451094
Name:KOSKI, JONAH SAMUEL (PT, DPT)
Entity Type:Individual
Prefix:
First Name:JONAH
Middle Name:SAMUEL
Last Name:KOSKI
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1310 SE REED MARKET RD STE 130
Mailing Address - Street 2:
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97702-3584
Mailing Address - Country:US
Mailing Address - Phone:503-610-9281
Mailing Address - Fax:
Practice Address - Street 1:1310 SE REED MARKET RD
Practice Address - Street 2:
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97702-3583
Practice Address - Country:US
Practice Address - Phone:503-610-9281
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-18
Last Update Date:2023-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR64202208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation