Provider Demographics
NPI:1407152309
Name:KOZAK, NANCY (PT)
Entity Type:Individual
Prefix:MRS
First Name:NANCY
Middle Name:
Last Name:KOZAK
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10099 SEMINOLE BLVD
Mailing Address - Street 2:SUITE A
Mailing Address - City:SEMINOLE
Mailing Address - State:FL
Mailing Address - Zip Code:33772-2540
Mailing Address - Country:US
Mailing Address - Phone:727-399-8226
Mailing Address - Fax:727-393-4823
Practice Address - Street 1:10099 SEMINOLE BLVD
Practice Address - Street 2:SUITE A
Practice Address - City:SEMINOLE
Practice Address - State:FL
Practice Address - Zip Code:33772-2540
Practice Address - Country:US
Practice Address - Phone:727-399-8226
Practice Address - Fax:727-393-4823
Is Sole Proprietor?:No
Enumeration Date:2011-02-10
Last Update Date:2011-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT65437225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist