Provider Demographics
NPI:1841602711
Name:KOSER, KELLY J (PTA)
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:J
Last Name:KOSER
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:107 E ORANGE ST
Mailing Address - Street 2:APARTMENT 1
Mailing Address - City:SHIPPENSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17257-1911
Mailing Address - Country:US
Mailing Address - Phone:717-658-1699
Mailing Address - Fax:
Practice Address - Street 1:824 LISBURN RD
Practice Address - Street 2:
Practice Address - City:CAMP HILL
Practice Address - State:PA
Practice Address - Zip Code:17011-7102
Practice Address - Country:US
Practice Address - Phone:717-737-3373
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-05-28
Last Update Date:2014-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PATEI002008225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant