Healthcare Provider Details

I. General information

NPI: 1871253815
Provider Name (Legal Business Name): HAYLEY KOZAR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/17/2021
Last Update Date: 12/17/2021
Certification Date: 12/17/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 N MAIN ST
MANSFIELD MA
02048-3601
US

IV. Provider business mailing address

300 N MAIN ST
MANSFIELD MA
02048-3601
US

V. Phone/Fax

Practice location:
  • Phone: 508-639-5550
  • Fax:
Mailing address:
  • Phone: 508-639-5550
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number25920
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: