Provider Demographics
NPI:1013031780
Name:KOZIOL, CAROLYN A (PT)
Entity Type:Individual
Prefix:
First Name:CAROLYN
Middle Name:A
Last Name:KOZIOL
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:CAROLYN
Other - Middle Name:A
Other - Last Name:KOLAR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:790 REMINGTON BLVD
Mailing Address - Street 2:
Mailing Address - City:BOLINGBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60440-4909
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2940 ROLLINGRIDGE RD
Practice Address - Street 2:SUITE 200
Practice Address - City:NAPERVILLE
Practice Address - State:IL
Practice Address - Zip Code:60564-4231
Practice Address - Country:US
Practice Address - Phone:630-527-0485
Practice Address - Fax:630-527-0917
Is Sole Proprietor?:No
Enumeration Date:2007-03-19
Last Update Date:2010-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070012827225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILP00852575OtherMEDICARE RAILROAD
ILP00852575OtherMEDICARE RAILROAD
IL202845116Medicare PIN
ILK38121Medicare PIN