Healthcare Provider Details

I. General information

NPI: 1053145375
Provider Name (Legal Business Name): HAYDY KOZMAN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/28/2024
Last Update Date: 08/28/2024
Certification Date: 08/28/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4100 E FLETCHER AVE
TAMPA FL
33613-4864
US

IV. Provider business mailing address

4100 E FLETCHER AVE
TAMPA FL
33613-4864
US

V. Phone/Fax

Practice location:
  • Phone: 813-977-4950
  • Fax:
Mailing address:
  • Phone: 813-977-4950
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number42193
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: