Provider Demographics
NPI:1508838046
Name:BOZEKA, GREGORY GEORGE (LAT)
Entity Type:Individual
Prefix:MR
First Name:GREGORY
Middle Name:GEORGE
Last Name:BOZEKA
Suffix:
Gender:M
Credentials:LAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:217 CORDELIA ST SW
Mailing Address - Street 2:
Mailing Address - City:NORTH CANTON
Mailing Address - State:OH
Mailing Address - Zip Code:44720-3503
Mailing Address - Country:US
Mailing Address - Phone:330-497-7295
Mailing Address - Fax:
Practice Address - Street 1:OHIO UNIVERSITY
Practice Address - Street 2:GROVER E207
Practice Address - City:ATHENS
Practice Address - State:OH
Practice Address - Zip Code:45701-2979
Practice Address - Country:US
Practice Address - Phone:740-593-9497
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH0026302255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer