Provider Demographics
NPI:1538182977
Name:KOSOBUCKI, CHRISTOPHER JOHN (PT)
Entity type:Individual
Prefix:DR
First Name:CHRISTOPHER
Middle Name:JOHN
Last Name:KOSOBUCKI
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6224 FAYETTEVILLE RD.
Mailing Address - Street 2:STE. 101
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27713
Mailing Address - Country:US
Mailing Address - Phone:919-484-0033
Mailing Address - Fax:919-484-3008
Practice Address - Street 1:6224 FAYETTEVILLE RD.
Practice Address - Street 2:STE. 101
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27713
Practice Address - Country:US
Practice Address - Phone:919-484-0033
Practice Address - Fax:919-486-3008
Is Sole Proprietor?:No
Enumeration Date:2006-07-26
Last Update Date:2013-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC97372251X0800X, 225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC079TROtherBLUE CROSS BLUE SHIELD
NC2504250AMedicare UPIN