Healthcare Provider Details

I. General information

NPI: 1689899114
Provider Name (Legal Business Name): LOIDA KOZBIEL MPT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/17/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10252 HUNTER TRL
HUNTLEY IL
60142-4081
US

IV. Provider business mailing address

10252 HUNTER TRL
HUNTLEY IL
60142-4081
US

V. Phone/Fax

Practice location:
  • Phone: 847-515-1518
  • Fax:
Mailing address:
  • Phone: 847-515-1518
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: