Provider Demographics
NPI:1386710077
Name:KOKOSKIE, JUSTIN F (ATC)
Entity type:Individual
Prefix:MR
First Name:JUSTIN
Middle Name:F
Last Name:KOKOSKIE
Suffix:
Gender:M
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9241 E DESERT COVE CIR
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85730-1359
Mailing Address - Country:US
Mailing Address - Phone:520-519-6944
Mailing Address - Fax:520-621-8771
Practice Address - Street 1:1 NATIONAL CHAMPIONSHIP DRIVE, N108
Practice Address - Street 2:THE UNIVERSITY OF ARIZONA
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85721-0096
Practice Address - Country:US
Practice Address - Phone:520-621-4568
Practice Address - Fax:520-621-8771
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ0245261QS1000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS1000XAmbulatory Health Care FacilitiesClinic/CenterStudent Health