Provider Demographics
NPI:1013455708
Name:KOSMOS, MELYNDA
Entity Type:Individual
Prefix:MRS
First Name:MELYNDA
Middle Name:
Last Name:KOSMOS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6 FELHURST CT
Mailing Address - Street 2:
Mailing Address - City:SIMPSONVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29681-6546
Mailing Address - Country:US
Mailing Address - Phone:864-412-8900
Mailing Address - Fax:
Practice Address - Street 1:6 FELHURST CT
Practice Address - Street 2:
Practice Address - City:SIMPSONVILLE
Practice Address - State:SC
Practice Address - Zip Code:29681-6546
Practice Address - Country:US
Practice Address - Phone:864-412-8900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-02-02
Last Update Date:2017-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist