Provider Demographics
NPI:1679910004
Name:COSNER, BRAD DOUGLAS (LPTA)
Entity type:Individual
Prefix:MR
First Name:BRAD
Middle Name:DOUGLAS
Last Name:COSNER
Suffix:
Gender:M
Credentials:LPTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4911 SW 19TH ST
Mailing Address - Street 2:
Mailing Address - City:DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50315-4487
Mailing Address - Country:US
Mailing Address - Phone:515-285-2559
Mailing Address - Fax:515-285-6487
Practice Address - Street 1:4911 SW 19TH ST
Practice Address - Street 2:
Practice Address - City:DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50315-4487
Practice Address - Country:US
Practice Address - Phone:515-285-2559
Practice Address - Fax:515-285-6487
Is Sole Proprietor?:No
Enumeration Date:2013-05-24
Last Update Date:2013-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA001201225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant