Provider Demographics
NPI:1477677847
Name:KOZLOWSKI, DELLA A M (PTA)
Entity Type:Individual
Prefix:MRS
First Name:DELLA
Middle Name:A M
Last Name:KOZLOWSKI
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:19 BLAINE AVE
Mailing Address - Street 2:
Mailing Address - City:BEVERLY
Mailing Address - State:MA
Mailing Address - Zip Code:01915-2503
Mailing Address - Country:US
Mailing Address - Phone:978-777-3740
Mailing Address - Fax:978-777-2704
Practice Address - Street 1:90 LINDALL ST
Practice Address - Street 2:REHAB DEPT.
Practice Address - City:DANVERS
Practice Address - State:MA
Practice Address - Zip Code:01923-2125
Practice Address - Country:US
Practice Address - Phone:978-777-3740
Practice Address - Fax:978-777-2704
Is Sole Proprietor?:No
Enumeration Date:2007-03-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA7748225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant