Provider Demographics
NPI:1255637245
Name:COSGROVE F.A.S.T. SYSTEMS INC.
Entity type:Organization
Organization Name:COSGROVE F.A.S.T. SYSTEMS INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR: PHYSICAL THERAPY SERVICES
Authorized Official - Prefix:MRS
Authorized Official - First Name:AMY
Authorized Official - Middle Name:LYNNE
Authorized Official - Last Name:WUNSCH
Authorized Official - Suffix:
Authorized Official - Credentials:MSPT
Authorized Official - Phone:310-430-0005
Mailing Address - Street 1:24420 WALNUT ST # 8232
Mailing Address - Street 2:
Mailing Address - City:NEWHALL
Mailing Address - State:CA
Mailing Address - Zip Code:91321-2822
Mailing Address - Country:US
Mailing Address - Phone:661-799-7900
Mailing Address - Fax:661-799-7371
Practice Address - Street 1:24420 WALNUT ST # 8232
Practice Address - Street 2:
Practice Address - City:NEWHALL
Practice Address - State:CA
Practice Address - Zip Code:91321-2822
Practice Address - Country:US
Practice Address - Phone:661-799-7900
Practice Address - Fax:661-799-7371
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-02-08
Last Update Date:2011-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA29208261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy