Healthcare Provider Details

I. General information

NPI: 1144792201
Provider Name (Legal Business Name): EMILY IRENE COZINE PT, DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/28/2018
Last Update Date: 10/15/2025
Certification Date: 10/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3883 AIRWAY DR
SANTA ROSA CA
95403-1670
US

IV. Provider business mailing address

2311 MOONLIGHT WAY
SANTA ROSA CA
95403-8909
US

V. Phone/Fax

Practice location:
  • Phone: 707-521-8962
  • Fax:
Mailing address:
  • Phone: 619-719-0386
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT295171
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License NumberPT295171
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: