Healthcare Provider Details

I. General information

NPI: 1831214840
Provider Name (Legal Business Name): FRANK JOHN KOZDRAS LMT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/20/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

27373 SAN MARCO DR
PUNTA GORDA FL
33983-8749
US

IV. Provider business mailing address

210 WOOD ST
PUNTA GORDA FL
33950-3845
US

V. Phone/Fax

Practice location:
  • Phone: 941-380-0330
  • Fax:
Mailing address:
  • Phone: 941-833-5717
  • Fax: 941-833-5715

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMA29367
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: