Provider Demographics
NPI:1780772871
Name:BOZLEE, ELIZABETH Z (PT)
Entity type:Individual
Prefix:MRS
First Name:ELIZABETH
Middle Name:Z
Last Name:BOZLEE
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14478 AERIE RD
Mailing Address - Street 2:
Mailing Address - City:GULFPORT
Mailing Address - State:MS
Mailing Address - Zip Code:39503-8111
Mailing Address - Country:US
Mailing Address - Phone:228-617-4034
Mailing Address - Fax:228-831-8177
Practice Address - Street 1:14478 AERIE RD
Practice Address - Street 2:
Practice Address - City:GULFPORT
Practice Address - State:MS
Practice Address - Zip Code:39503
Practice Address - Country:US
Practice Address - Phone:228-617-4034
Practice Address - Fax:228-831-8177
Is Sole Proprietor?:No
Enumeration Date:2006-10-11
Last Update Date:2018-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSPT1109208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS02354712Medicaid
MS650000248Medicare PIN
MSP00139347Medicare ID - Type UnspecifiedRAILROAD MEDICARE