Provider Demographics
NPI:1609195668
Name:MARK KOZMAN, LLC
Entity Type:Organization
Organization Name:MARK KOZMAN, LLC
Other - Org Name:DIRECTREATMENT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:KOZMAN
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:817-797-7304
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:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-05-28
Last Update Date:2010-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1115897225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty