Provider Demographics
NPI:1295042364
Name:COZART, CAMERON (LMP)
Entity Type:Individual
Prefix:MR
First Name:CAMERON
Middle Name:
Last Name:COZART
Suffix:
Gender:M
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8025 12TH AVE NE
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98115-4322
Mailing Address - Country:US
Mailing Address - Phone:425-770-4194
Mailing Address - Fax:
Practice Address - Street 1:8025 12TH AVE NE
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98115-4322
Practice Address - Country:US
Practice Address - Phone:425-770-4194
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-09
Last Update Date:2012-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60126504225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAMA60126504OtherWASHINGTON STATE DEPARTMENT OF HEALTH