Provider Demographics
NPI:1841567161
Name:COSSAR, TRICIA-FAE (LMT, PTA)
Entity type:Individual
Prefix:
First Name:TRICIA-FAE
Middle Name:
Last Name:COSSAR
Suffix:
Gender:F
Credentials:LMT, PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1343 OHIO ST TRLR 8
Mailing Address - Street 2:
Mailing Address - City:BANGOR
Mailing Address - State:ME
Mailing Address - Zip Code:04401-2718
Mailing Address - Country:US
Mailing Address - Phone:207-416-8820
Mailing Address - Fax:
Practice Address - Street 1:116 HAMMOND ST STE 1
Practice Address - Street 2:
Practice Address - City:BANGOR
Practice Address - State:ME
Practice Address - Zip Code:04401-4915
Practice Address - Country:US
Practice Address - Phone:207-416-8820
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-01
Last Update Date:2025-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEMT6836225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist