Provider Demographics
NPI:1932323839
Name:KOZAK P T & ASSOC INC
Entity Type:Organization
Organization Name:KOZAK P T & ASSOC INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:ANDREW
Authorized Official - Last Name:KOZAK
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:727-399-8226
Mailing Address - Street 1:10099 SEMINOLE BLVD
Mailing Address - Street 2:SUITE 5A
Mailing Address - City:SEMINOLE
Mailing Address - State:FL
Mailing Address - Zip Code:33772-2521
Mailing Address - Country:US
Mailing Address - Phone:727-399-8226
Mailing Address - Fax:727-393-4823
Practice Address - Street 1:10099 SEMINOLE BLVD
Practice Address - Street 2:SUITE 5A
Practice Address - City:SEMINOLE
Practice Address - State:FL
Practice Address - Zip Code:33772-2521
Practice Address - Country:US
Practice Address - Phone:727-399-8226
Practice Address - Fax:727-393-4823
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-12
Last Update Date:2013-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT 32712251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedicGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLR5HOtherBCBS
FL5288337OtherAETNA
FL890763300Medicaid
FLY4593OtherBCBS
FL360474900OtherACS
FL890763300Medicaid
FL=========OtherHUMANA
FL=========OtherUNIVERSAL
FLR5HOtherBCBS
FL106844Medicare ID - Type Unspecified