Provider Demographics
NPI:1609520212
Name:HOZESKA, KIM LEANNE (LPTA)
Entity Type:Individual
Prefix:MRS
First Name:KIM
Middle Name:LEANNE
Last Name:HOZESKA
Suffix:
Gender:F
Credentials:LPTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2806 BURNS RD
Mailing Address - Street 2:
Mailing Address - City:MUNGER
Mailing Address - State:MI
Mailing Address - Zip Code:48747-9751
Mailing Address - Country:US
Mailing Address - Phone:989-450-4543
Mailing Address - Fax:
Practice Address - Street 1:568 N PINE RD
Practice Address - Street 2:
Practice Address - City:BAY CITY
Practice Address - State:MI
Practice Address - Zip Code:48708-9190
Practice Address - Country:US
Practice Address - Phone:989-778-1713
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-11
Last Update Date:2022-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5502001124225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy AssistantGroup - Single Specialty