Provider Demographics
NPI:1063193415
Name:KOSIK ENTERPRISE, LLC
Entity type:Organization
Organization Name:KOSIK ENTERPRISE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PT AND OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SYDNEY
Authorized Official - Middle Name:LEAH
Authorized Official - Last Name:KOSIK
Authorized Official - Suffix:
Authorized Official - Credentials:PT, DPT
Authorized Official - Phone:570-332-4924
Mailing Address - Street 1:10031 GRAND CANAL DR UNIT 18302
Mailing Address - Street 2:
Mailing Address - City:WINDERMERE
Mailing Address - State:FL
Mailing Address - Zip Code:34786-5861
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1620 DANIELS RD STE 130
Practice Address - Street 2:
Practice Address - City:WINTER GARDEN
Practice Address - State:FL
Practice Address - Zip Code:34787-5604
Practice Address - Country:US
Practice Address - Phone:570-332-4924
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-07-28
Last Update Date:2023-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy