Provider Demographics
NPI:1407862360
Name:KOZMAN, MARK A (PT)
Entity Type:Individual
Prefix:MR
First Name:MARK
Middle Name:A
Last Name:KOZMAN
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 1:8212 LOST MAPLE DR
Mailing Address - Street 2:
Mailing Address - City:NORTH RICHLAND HILLS
Mailing Address - State:TX
Mailing Address - Zip Code:76182-8430
Mailing Address - Country:US
Mailing Address - Phone:817-797-7304
Mailing Address - Fax:
Practice Address - Street 1:8212 LOST MAPLE DR
Practice Address - Street 2:
Practice Address - City:NORTH RICHLAND HILLS
Practice Address - State:TX
Practice Address - Zip Code:76182-8430
Practice Address - Country:US
Practice Address - Phone:817-797-7304
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-31
Last Update Date:2010-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1115897225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8D8033Medicare ID - Type Unspecified