Basic Information
| Provider Information | |||||||||
| NPI: | 1639542996 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | COSEY | ||||||||
| FirstName: | GABRE | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | MISS | ||||||||
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| Credential: | ATC, LAT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 23 LAKE COVE LN | ||||||||
| Address2: | |||||||||
| City: | FELTON | ||||||||
| State: | DE | ||||||||
| PostalCode: | 199435352 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3022330658 | ||||||||
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| Practice Location | |||||||||
| Address1: | 914 N DUPONT BLVD STE C | ||||||||
| Address2: | |||||||||
| City: | MILFORD | ||||||||
| State: | DE | ||||||||
| PostalCode: | 199631044 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3024226670 | ||||||||
| FaxNumber: | 3024225660 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/09/2015 | ||||||||
| LastUpdateDate: | 03/25/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2255A2300X | J3-0000705 | DE | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Specialist/Technologist | Athletic Trainer |
No ID Information.