Provider Demographics
NPI:1629139936
Name:KOZEMSKI, PATRICK (PT)
Entity Type:Individual
Prefix:
First Name:PATRICK
Middle Name:
Last Name:KOZEMSKI
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1531 SOUTH 8TH STREET
Mailing Address - Street 2:APT 503
Mailing Address - City:ST LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63104
Mailing Address - Country:US
Mailing Address - Phone:314-972-2050
Mailing Address - Fax:
Practice Address - Street 1:1531 S 8TH ST
Practice Address - Street 2:APT 503
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63104-3838
Practice Address - Country:US
Practice Address - Phone:314-972-2050
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2005040397225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist