Healthcare Provider Details

I. General information

NPI: 1154693760
Provider Name (Legal Business Name): MARYANNE MARGARET KOZAK P.T.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MARYANNE MARGARET GILBERT P.T.

II. Dates (important events)

Enumeration Date: 01/30/2012
Last Update Date: 01/30/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 REISTERSTOWN RD SUITE 210
PIKESVILLE MD
21208-5105
US

IV. Provider business mailing address

600 REISTERSTOWN RD SUITE 210
PIKESVILLE MD
21208-5105
US

V. Phone/Fax

Practice location:
  • Phone: 410-415-5374
  • Fax: 410-415-5375
Mailing address:
  • Phone: 410-415-5374
  • Fax: 410-415-5375

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number21257
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: