Individual
IGOR KOSCIUCH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
BSPT
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
070009754
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
070009754
STATE LICENSE
IL
Enumeration date
08/21/2008
Last updated
02/19/2024
Update your record
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