Healthcare Provider Details

I. General information

NPI: 1780295477
Provider Name (Legal Business Name): ERICK J KOZLOWSKI ATC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/14/2020
Last Update Date: 08/14/2020
Certification Date: 08/14/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2168 FIELD HOUSE DR
US AIR FORCE CO
80840-9599
US

IV. Provider business mailing address

745 DERRY PL
COLORADO SPRINGS CO
80918-7068
US

V. Phone/Fax

Practice location:
  • Phone: 719-333-0214
  • Fax:
Mailing address:
  • Phone: 719-963-7340
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: