Provider Demographics
NPI:1790548253
Name:KOZERSKI, KEVIN J (DPT)
Entity Type:Individual
Prefix:
First Name:KEVIN
Middle Name:J
Last Name:KOZERSKI
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:150 FERNWOOD DR
Mailing Address - Street 2:
Mailing Address - City:BEAR CREEK TOWNSHIP
Mailing Address - State:PA
Mailing Address - Zip Code:18702-8400
Mailing Address - Country:US
Mailing Address - Phone:570-472-1161
Mailing Address - Fax:
Practice Address - Street 1:1157 LACKAWANNA TRL
Practice Address - Street 2:
Practice Address - City:CLARKS SUMMIT
Practice Address - State:PA
Practice Address - Zip Code:18411-9260
Practice Address - Country:US
Practice Address - Phone:570-586-7764
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-02-06
Last Update Date:2024-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT032060225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist