Provider Demographics
NPI:1871867424
Name:KOZAK, KATHERINE EMILY (DPT)
Entity Type:Individual
Prefix:
First Name:KATHERINE
Middle Name:EMILY
Last Name:KOZAK
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11945 LITHOPOLIS RD NW
Mailing Address - Street 2:NW RT. #2
Mailing Address - City:CANAL WINCHESTER
Mailing Address - State:OH
Mailing Address - Zip Code:43110-9585
Mailing Address - Country:US
Mailing Address - Phone:617-837-4381
Mailing Address - Fax:614-833-4266
Practice Address - Street 1:11945 LITHOPOLIS RD NW
Practice Address - Street 2:NW RT. #2
Practice Address - City:CANAL WINCHESTER
Practice Address - State:OH
Practice Address - Zip Code:43110-9585
Practice Address - Country:US
Practice Address - Phone:617-837-4381
Practice Address - Fax:614-833-4266
Is Sole Proprietor?:No
Enumeration Date:2012-02-29
Last Update Date:2012-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPT.013610225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist