Provider Demographics
NPI:1326321837
Name:COZEAN, NICOLE DANIELLE (PT, DPT, WCS)
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:DANIELLE
Last Name:COZEAN
Suffix:
Gender:F
Credentials:PT, DPT, WCS
Other - Prefix:
Other - First Name:NICOLE
Other - Middle Name:DANIELLE
Other - Last Name:VASQUEZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT, DPT, WCS
Mailing Address - Street 1:25401 CABOT ROAD
Mailing Address - Street 2:SUITE 121
Mailing Address - City:LAGUNA HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:92653-5513
Mailing Address - Country:US
Mailing Address - Phone:949-393-1113
Mailing Address - Fax:949-438-0074
Practice Address - Street 1:25401 CABOT ROAD
Practice Address - Street 2:SUITE 121
Practice Address - City:LAGUNA HILLS
Practice Address - State:CA
Practice Address - Zip Code:92653-5513
Practice Address - Country:US
Practice Address - Phone:949-393-1113
Practice Address - Fax:949-438-0074
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-21
Last Update Date:2016-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA33488225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist