Healthcare Provider Details

I. General information

NPI: 1124400874
Provider Name (Legal Business Name): ALEX KOZIOL
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/18/2015
Last Update Date: 06/18/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2305 S 10TH ST
OMAHA NE
68108-1108
US

IV. Provider business mailing address

16106 COTTONWOOD ST
OMAHA NE
68136-3248
US

V. Phone/Fax

Practice location:
  • Phone: 402-345-1542
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number1121
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: