Provider Demographics
NPI:1275954760
Name:KOZIOL, PAWEL
Entity Type:Individual
Prefix:
First Name:PAWEL
Middle Name:
Last Name:KOZIOL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:39417 BURNS DR
Mailing Address - Street 2:
Mailing Address - City:STERLING HEIGHTS
Mailing Address - State:MI
Mailing Address - Zip Code:48313-5033
Mailing Address - Country:US
Mailing Address - Phone:313-415-8944
Mailing Address - Fax:586-838-4753
Practice Address - Street 1:39417 BURNS DR
Practice Address - Street 2:
Practice Address - City:STERLING HEIGHTS
Practice Address - State:MI
Practice Address - Zip Code:48313-5033
Practice Address - Country:US
Practice Address - Phone:313-415-8944
Practice Address - Fax:586-838-4753
Is Sole Proprietor?:Yes
Enumeration Date:2013-12-30
Last Update Date:2013-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIL2286912225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant