Healthcare Provider Details

I. General information

NPI: 1609520212
Provider Name (Legal Business Name): KIM LEANNE HOZESKA LPTA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/11/2022
Last Update Date: 02/11/2022
Certification Date: 02/11/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

568 N PINE RD
BAY CITY MI
48708-9190
US

IV. Provider business mailing address

2806 BURNS RD
MUNGER MI
48747-9751
US

V. Phone/Fax

Practice location:
  • Phone: 989-778-1713
  • Fax:
Mailing address:
  • Phone: 989-450-4543
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number5502001124
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: