Provider Demographics
NPI:1508935933
Name:KOZEL, SHELLEY V (PT PCS)
Entity Type:Individual
Prefix:
First Name:SHELLEY
Middle Name:V
Last Name:KOZEL
Suffix:
Gender:F
Credentials:PT PCS
Other - Prefix:
Other - First Name:SHELLEY
Other - Middle Name:V
Other - Last Name:THREADGILL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:115 NORTHRIDGE
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78209
Mailing Address - Country:US
Mailing Address - Phone:210-326-0734
Mailing Address - Fax:210-832-0734
Practice Address - Street 1:15316 HUEBNER RD #202
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78248
Practice Address - Country:US
Practice Address - Phone:210-614-4567
Practice Address - Fax:210-614-4999
Is Sole Proprietor?:No
Enumeration Date:2006-11-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX10382222251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8T4874OtherBCBS
TX8T4329OtherBCBS