Healthcare Provider Details

I. General information

NPI: 1285768408
Provider Name (Legal Business Name): BARBARA KOZAK PTA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/16/2007
Last Update Date: 03/11/2025
Certification Date: 03/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1467 N ELSTON AVE STE 103
CHICAGO IL
60642-2449
US

IV. Provider business mailing address

1620 N LA SALLE DR
CHICAGO IL
60614-6005
US

V. Phone/Fax

Practice location:
  • Phone: 312-943-3600
  • Fax:
Mailing address:
  • Phone: 312-943-3600
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number160002182
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: