Provider Demographics
NPI:1295892214
Name:KOSSUTH, CATHY (RPT)
Entity type:Individual
Prefix:MS
First Name:CATHY
Middle Name:
Last Name:KOSSUTH
Suffix:
Gender:F
Credentials:RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15240 DEER PARK LN
Mailing Address - Street 2:
Mailing Address - City:SAINT JAMES
Mailing Address - State:MO
Mailing Address - Zip Code:65559-9079
Mailing Address - Country:US
Mailing Address - Phone:573-263-3631
Mailing Address - Fax:
Practice Address - Street 1:15240 DEER PARK LN
Practice Address - Street 2:
Practice Address - City:SAINT JAMES
Practice Address - State:MO
Practice Address - Zip Code:65559-9079
Practice Address - Country:US
Practice Address - Phone:573-263-3631
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-02
Last Update Date:2008-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO110765225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist