Provider Demographics
NPI:1174576128
Name:KOSCINSKI, STACY ANN (MSPT)
Entity type:Individual
Prefix:
First Name:STACY
Middle Name:ANN
Last Name:KOSCINSKI
Suffix:
Gender:F
Credentials:MSPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12727 KIMBERLEY LN
Mailing Address - Street 2:STE 103
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77024-4047
Mailing Address - Country:US
Mailing Address - Phone:713-365-9338
Mailing Address - Fax:
Practice Address - Street 1:4009 BELLAIRE BLVD
Practice Address - Street 2:SUITE M
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77025-1168
Practice Address - Country:US
Practice Address - Phone:713-669-0042
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-19
Last Update Date:2016-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX11442102251N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251N0400XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1144210OtherLICENSE
TX1046077OtherBLUE LINK NUMBER
TX8C6974Medicare PIN