Healthcare Provider Details

I. General information

NPI: 1780162883
Provider Name (Legal Business Name): THERESA LYNN KOZIELL PT,MT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/31/2018
Last Update Date: 07/31/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

133 STATE ST
GUILFORD CT
06437-2471
US

IV. Provider business mailing address

439 N RIVER STREET
GUILFORD CT
06437-2430
US

V. Phone/Fax

Practice location:
  • Phone: 570-903-8153
  • Fax: 203-453-2822
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number10046
License Number StateCT
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number006885
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: