Individual
KEVIN KOSTKA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
P.T.
Contact information
Practice address
1790 HAMILL RD, HIXSON, TN 37343-4905
(423) 842-9322
(866) 591-0619
Mailing address
1790 HAMILL RD, HIXSON, TN 37343-4905
(423) 842-9322
(186) 659-1061
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
6817
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
11822955
CAQH
TN
05
—
3645730
—
TN
01
—
4227742
BCBS TENN
TN
Enumeration date
04/06/2006
Last updated
01/19/2015
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