Most Relevant Information
Provider Data
| NPI Number: | 1003560012 |
| Provider Name: | IMMACULATE JEMAIYO KOSGEI PTA |
| Entity Type: | Individual |
| Taxonomy Code: | 225200000X |
| Specialty: | Physical Therapy Assistant |
| License Number: | PTA.0014941 |
Most Important Dates
| Enumeration Date: | 02/08/2022 |
| Last Updated: | 02/08/2022 |
Provider Practice Location
9798 DESERT LILY CIR
COLORADO SPRINGS
CO
809251184
Practice Location Phone/Fax
| Phone: | 2054139369 |
| Fax: |
Provider Mailing Location
9798 DESERT LILY CIR
COLORADO SPRINGS
CO
809251184
Provider Mailing Phone/Fax
| Phone: | 2054139369 |
| Fax: |