Provider Demographics
NPI:1255722773
Name:COSCE, MARIO CHRISTOPHER (MS, ATC)
Entity type:Individual
Prefix:
First Name:MARIO
Middle Name:CHRISTOPHER
Last Name:COSCE
Suffix:
Gender:M
Credentials:MS, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:317 DEER RUN RD
Mailing Address - Street 2:
Mailing Address - City:ELGIN
Mailing Address - State:SC
Mailing Address - Zip Code:29045-8609
Mailing Address - Country:US
Mailing Address - Phone:502-643-0616
Mailing Address - Fax:
Practice Address - Street 1:317 DEER RUN RD
Practice Address - Street 2:
Practice Address - City:ELGIN
Practice Address - State:SC
Practice Address - Zip Code:29045-8609
Practice Address - Country:US
Practice Address - Phone:502-643-0616
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-02-06
Last Update Date:2015-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC12222255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer