Provider Demographics
NPI:1346462470
Name:KOZAK, DENNIS KEITH (PT)
Entity Type:Individual
Prefix:MR
First Name:DENNIS
Middle Name:KEITH
Last Name:KOZAK
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:138 CHESTNUT VALLEY DRIVE
Mailing Address - Street 2:
Mailing Address - City:DOYLESTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18901-2219
Mailing Address - Country:US
Mailing Address - Phone:215-230-1722
Mailing Address - Fax:
Practice Address - Street 1:138 CHESTNUT VALLEY DRIVE
Practice Address - Street 2:
Practice Address - City:DOYLESTOWN
Practice Address - State:PA
Practice Address - Zip Code:18901-2219
Practice Address - Country:US
Practice Address - Phone:215-230-1722
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT000918E2251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA000199993OtherHIGHMARK BLUE SHIELD ID
PA0033451000Other10 DIGIT HMO ID