Provider Demographics
NPI:1174947782
Name:KOSAK, KALEY
Entity type:Individual
Prefix:
First Name:KALEY
Middle Name:
Last Name:KOSAK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3277 E LOUISE DR
Mailing Address - Street 2:SUITE 410
Mailing Address - City:MERIDIAN
Mailing Address - State:ID
Mailing Address - Zip Code:83642-9359
Mailing Address - Country:US
Mailing Address - Phone:208-489-5825
Mailing Address - Fax:208-489-4065
Practice Address - Street 1:3277 E LOUISE DR
Practice Address - Street 2:SUITE 410
Practice Address - City:MERIDIAN
Practice Address - State:ID
Practice Address - Zip Code:83642-9359
Practice Address - Country:US
Practice Address - Phone:208-489-5825
Practice Address - Fax:208-489-4065
Is Sole Proprietor?:No
Enumeration Date:2014-02-18
Last Update Date:2014-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDPT-2723225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist