Provider Demographics
NPI:1316207426
Name:LINDA DITLEV KOZORA PT INC
Entity Type:Organization
Organization Name:LINDA DITLEV KOZORA PT INC
Other - Org Name:WAVELENGTH PHSYCIAL THERAPY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:DAWNITTA
Authorized Official - Middle Name:D
Authorized Official - Last Name:SCHELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:509-325-1977
Mailing Address - Street 1:120 W BUCKEYE AVE
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99205-3117
Mailing Address - Country:US
Mailing Address - Phone:509-325-1977
Mailing Address - Fax:
Practice Address - Street 1:621 W MALLON AVE # 606
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99201-2163
Practice Address - Country:US
Practice Address - Phone:509-325-1977
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-22
Last Update Date:2012-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT00003514225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty