Provider Demographics
NPI:1164858841
Name:KOZLOWSKI, KIRK ALEXANDER (PT)
Entity Type:Individual
Prefix:
First Name:KIRK
Middle Name:ALEXANDER
Last Name:KOZLOWSKI
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2815 DUSTIN RD STE B
Mailing Address - Street 2:
Mailing Address - City:OREGON
Mailing Address - State:OH
Mailing Address - Zip Code:43616-3497
Mailing Address - Country:US
Mailing Address - Phone:419-693-0676
Mailing Address - Fax:419-693-0807
Practice Address - Street 1:2815 DUSTIN RD STE B
Practice Address - Street 2:
Practice Address - City:OREGON
Practice Address - State:OH
Practice Address - Zip Code:43616-3497
Practice Address - Country:US
Practice Address - Phone:419-693-0676
Practice Address - Fax:419-693-0807
Is Sole Proprietor?:No
Enumeration Date:2013-09-25
Last Update Date:2013-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH014434225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist