Provider Demographics
NPI:1083892996
Name:KOZEMSKI, BRANDI MARIE (PT)
Entity Type:Individual
Prefix:MRS
First Name:BRANDI
Middle Name:MARIE
Last Name:KOZEMSKI
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:BRANDI
Other - Middle Name:MARIE
Other - Last Name:NORGREN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:700 E MARSHALL AVE
Mailing Address - Street 2:
Mailing Address - City:LONGVIEW
Mailing Address - State:TX
Mailing Address - Zip Code:75601
Mailing Address - Country:US
Mailing Address - Phone:903-315-5580
Mailing Address - Fax:903-315-2804
Practice Address - Street 1:700 E MARSHALL AVE
Practice Address - Street 2:
Practice Address - City:LONGVIEW
Practice Address - State:TX
Practice Address - Zip Code:75601
Practice Address - Country:US
Practice Address - Phone:903-315-5580
Practice Address - Fax:903-315-2804
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-01
Last Update Date:2008-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX11626062081S0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2081S0010XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationSports Medicine