Healthcare Provider Details

I. General information

NPI: 1275954760
Provider Name (Legal Business Name): PAWEL KOZIOL
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/30/2013
Last Update Date: 12/30/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

39417 BURNS DR
STERLING HEIGHTS MI
48313-5033
US

IV. Provider business mailing address

39417 BURNS DR
STERLING HEIGHTS MI
48313-5033
US

V. Phone/Fax

Practice location:
  • Phone: 313-415-8944
  • Fax: 586-838-4753
Mailing address:
  • Phone: 313-415-8944
  • Fax: 586-838-4753

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License NumberL2286912
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: