Provider Demographics
NPI:1255506648
Name:KOZIATEK, LAURA (RPT)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:
Last Name:KOZIATEK
Suffix:
Gender:F
Credentials:RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:32 UPPER WALNUT HILL RD
Mailing Address - Street 2:
Mailing Address - City:EAST LYME
Mailing Address - State:CT
Mailing Address - Zip Code:06333-1021
Mailing Address - Country:US
Mailing Address - Phone:860-440-0764
Mailing Address - Fax:
Practice Address - Street 1:4 GREENTREE DR
Practice Address - Street 2:
Practice Address - City:WATERFORD
Practice Address - State:CT
Practice Address - Zip Code:06385-4116
Practice Address - Country:US
Practice Address - Phone:860-442-0647
Practice Address - Fax:860-437-0123
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-25
Last Update Date:2008-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT002433225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist