Provider Demographics
NPI:1083869283
Name:BOZART - DOW, KIMBERLY JANEEN
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:JANEEN
Last Name:BOZART - DOW
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:KIMBERLY
Other - Middle Name:JANEEN
Other - Last Name:BOZART
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1550 W CRAIG RD STE 210
Mailing Address - Street 2:
Mailing Address - City:NORTH LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89032-0329
Mailing Address - Country:US
Mailing Address - Phone:702-360-9142
Mailing Address - Fax:
Practice Address - Street 1:1550 W CRAIG RD STE 210
Practice Address - Street 2:
Practice Address - City:NORTH LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89032-0329
Practice Address - Country:US
Practice Address - Phone:702-360-9142
Practice Address - Fax:702-878-2018
Is Sole Proprietor?:No
Enumeration Date:2008-12-02
Last Update Date:2024-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV3725225100000X
CAPT330782251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGO861YMedicare PIN