Provider Demographics
NPI:1912410382
Name:BRZOZOWSKI, KELLY A (PT)
Entity type:Individual
Prefix:
First Name:KELLY
Middle Name:A
Last Name:BRZOZOWSKI
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:KELLY
Other - Middle Name:A
Other - Last Name:KAZMAREK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:24400 HIGHPOINT RD STE 10
Mailing Address - Street 2:
Mailing Address - City:BEACHWOOD
Mailing Address - State:OH
Mailing Address - Zip Code:44122-6027
Mailing Address - Country:US
Mailing Address - Phone:216-896-0824
Mailing Address - Fax:216-896-0825
Practice Address - Street 1:24400 HIGHPOINT RD STE 10
Practice Address - Street 2:
Practice Address - City:BEACHWOOD
Practice Address - State:OH
Practice Address - Zip Code:44122-6027
Practice Address - Country:US
Practice Address - Phone:216-896-0824
Practice Address - Fax:216-896-0825
Is Sole Proprietor?:No
Enumeration Date:2017-11-08
Last Update Date:2019-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPT005903208100000X, 225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation