Provider Demographics
NPI:1790395838
Name:KOZENY, MICHAELA (PT, DPT)
Entity Type:Individual
Prefix:
First Name:MICHAELA
Middle Name:
Last Name:KOZENY
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 26
Mailing Address - Street 2:
Mailing Address - City:LEMOYNE
Mailing Address - State:NE
Mailing Address - Zip Code:69146-0026
Mailing Address - Country:US
Mailing Address - Phone:402-960-0942
Mailing Address - Fax:
Practice Address - Street 1:1820 ILLINOIS ST
Practice Address - Street 2:
Practice Address - City:SIDNEY
Practice Address - State:NE
Practice Address - Zip Code:69162-1425
Practice Address - Country:US
Practice Address - Phone:308-225-1870
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-04
Last Update Date:2020-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE4087225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist