Provider Demographics
NPI:1053530527
Name:KOSACHEFF, ANNE (PT, CO)
Entity type:Individual
Prefix:
First Name:ANNE
Middle Name:
Last Name:KOSACHEFF
Suffix:
Gender:F
Credentials:PT, CO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 664
Mailing Address - Street 2:365 FIRST AVE
Mailing Address - City:BETHEL
Mailing Address - State:AK
Mailing Address - Zip Code:99559-0664
Mailing Address - Country:US
Mailing Address - Phone:907-545-4839
Mailing Address - Fax:907-543-3539
Practice Address - Street 1:365 FIRST AVE
Practice Address - Street 2:BOX 664
Practice Address - City:BETHEL
Practice Address - State:AK
Practice Address - Zip Code:99559-0664
Practice Address - Country:US
Practice Address - Phone:907-545-4839
Practice Address - Fax:907-543-3539
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-24
Last Update Date:2020-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK788261QP2000X, 225100000X
AKCO004846335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
No335E00000XSuppliersProsthetic/Orthotic Supplier