Provider Demographics
NPI:1649700105
Name:COSNER, CLINTON TYLER (DPT)
Entity type:Individual
Prefix:
First Name:CLINTON
Middle Name:TYLER
Last Name:COSNER
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1900 LOCUST AVE STE A
Mailing Address - Street 2:
Mailing Address - City:FAIRMONT
Mailing Address - State:WV
Mailing Address - Zip Code:26554-1293
Mailing Address - Country:US
Mailing Address - Phone:304-333-5222
Mailing Address - Fax:304-333-5224
Practice Address - Street 1:1900 LOCUST AVE STE A
Practice Address - Street 2:
Practice Address - City:FAIRMONT
Practice Address - State:WV
Practice Address - Zip Code:26554-1293
Practice Address - Country:US
Practice Address - Phone:304-333-5222
Practice Address - Fax:304-333-5224
Is Sole Proprietor?:No
Enumeration Date:2017-06-18
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist