Provider Demographics
NPI:1952857443
Name:KOZLOWSKI, JUSTIN ROBERT (PT, DPT)
Entity Type:Individual
Prefix:DR
First Name:JUSTIN
Middle Name:ROBERT
Last Name:KOZLOWSKI
Suffix:
Gender:M
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 1:154 BOW ST APT B
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28301-2300
Mailing Address - Country:US
Mailing Address - Phone:716-785-8282
Mailing Address - Fax:
Practice Address - Street 1:2 THE SQUARE AT LILLINGTON
Practice Address - Street 2:
Practice Address - City:LILLINGTON
Practice Address - State:NC
Practice Address - Zip Code:27546-8030
Practice Address - Country:US
Practice Address - Phone:910-893-2850
Practice Address - Fax:910-984-1515
Is Sole Proprietor?:No
Enumeration Date:2016-08-25
Last Update Date:2019-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP17796225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist