Provider Demographics
NPI:1821050311
Name:COSM REHAB
Entity Type:Organization
Organization Name:COSM REHAB
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF PHYSICAL THERAPY
Authorized Official - Prefix:
Authorized Official - First Name:DENNIS
Authorized Official - Middle Name:A
Authorized Official - Last Name:SCHULTZ
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:724-465-2676
Mailing Address - Street 1:1265 WAYNE AVE
Mailing Address - Street 2:119 PROFESSIONAL CENTER SUITE 307
Mailing Address - City:INDIANA
Mailing Address - State:PA
Mailing Address - Zip Code:15701-3501
Mailing Address - Country:US
Mailing Address - Phone:724-465-2676
Mailing Address - Fax:724-349-1830
Practice Address - Street 1:1265 WAYNE AVE
Practice Address - Street 2:119 PROFESSIONAL CENTER
Practice Address - City:INDIANA
Practice Address - State:PA
Practice Address - Zip Code:15701-3501
Practice Address - Country:US
Practice Address - Phone:724-465-2676
Practice Address - Fax:724-349-1830
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CENTER FOR ORTHOPEDICS AND SPORTS MEDICINE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-04-03
Last Update Date:2009-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT007180L225100000X
PAPT017316225100000X
PAPT016557225100000X
PAPT015947225100000X
PAOC003583L225XH1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No225XH1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistHandGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PACI1160OtherTRAVELERS MEDICARE
PA188868Medicare ID - Type Unspecified
PACI1160OtherTRAVELERS MEDICARE