Individual
ALICE KAY KOSHEVATSKIY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PT
Contact information
Practice address
615 6TH ST SE, STANLEY, ND 58784-4444
(701) 628-8646
Mailing address
PO BOX 399, STANLEY, ND 58784-0399
(701) 628-3823
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
070027454
IL
225100000X
Physical Therapist
Primary
16427
WI
225100000X
Physical Therapist
5779
HI
225100000X
Physical Therapist
CP022489T
ND
Other
Enumeration date
08/31/2023
Last updated
08/31/2023
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