Provider Demographics
NPI:1598101768
Name:KOZLOWSKI, EDMUND JOHN III (LMT)
Entity Type:Individual
Prefix:
First Name:EDMUND
Middle Name:JOHN
Last Name:KOZLOWSKI
Suffix:III
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18451 RED WILLOW WAY
Mailing Address - Street 2:
Mailing Address - City:LAND O LAKES
Mailing Address - State:FL
Mailing Address - Zip Code:34638-6060
Mailing Address - Country:US
Mailing Address - Phone:407-616-3952
Mailing Address - Fax:813-996-3873
Practice Address - Street 1:18451 RED WILLOW WAY
Practice Address - Street 2:
Practice Address - City:LAND O LAKES
Practice Address - State:FL
Practice Address - Zip Code:34638-6060
Practice Address - Country:US
Practice Address - Phone:407-616-3952
Practice Address - Fax:813-996-3873
Is Sole Proprietor?:No
Enumeration Date:2013-05-15
Last Update Date:2013-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA 69732225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist