Provider Demographics
NPI:1659347250
Name:COZORT, KEVIN (PT)
Entity Type:Individual
Prefix:
First Name:KEVIN
Middle Name:
Last Name:COZORT
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 1:1689 NONCONNAH BLVD
Mailing Address - Street 2:STE 100
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38132-2102
Mailing Address - Country:US
Mailing Address - Phone:901-396-1984
Mailing Address - Fax:901-396-1964
Practice Address - Street 1:1689 NONCONNAH BLVD
Practice Address - Street 2:STE 100
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38132-2102
Practice Address - Country:US
Practice Address - Phone:901-396-1984
Practice Address - Fax:901-396-1964
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN1614225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist