Healthcare Provider Details

I. General information

NPI: 1275696221
Provider Name (Legal Business Name): BARBRA KOCZAN PT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/19/2006
Last Update Date: 02/07/2024
Certification Date: 02/07/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1576 MERRITT BLVD STE 7
DUNDALK MD
21222-2114
US

IV. Provider business mailing address

6410 ROCKLEDGE DR NRH REGIONAL REHAB - SUITE 600
BETHESDA MD
20817-1809
US

V. Phone/Fax

Practice location:
  • Phone: 301-581-8054
  • Fax: 301-564-0284
Mailing address:
  • Phone: 301-581-8054
  • Fax: 301-564-0284

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number19276
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: