Provider Demographics
NPI:1912644592
Name:KOOCHAK KOSARI, PARSA (PT, DPT)
Entity Type:Individual
Prefix:DR
First Name:PARSA
Middle Name:
Last Name:KOOCHAK KOSARI
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6801 ELLSWORTH WALK
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78724-4525
Mailing Address - Country:US
Mailing Address - Phone:512-740-8191
Mailing Address - Fax:
Practice Address - Street 1:12617 RIDGELINE BLVD BLDG C105
Practice Address - Street 2:
Practice Address - City:CEDAR PARK
Practice Address - State:TX
Practice Address - Zip Code:78613-1606
Practice Address - Country:US
Practice Address - Phone:512-996-0441
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-16
Last Update Date:2023-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1360245225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty