Healthcare Provider Details

I. General information

NPI: 1598089450
Provider Name (Legal Business Name): ROBIN ADELE KOZLOWSKI LMT, PTA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/22/2010
Last Update Date: 03/22/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

42 E MAIN ST
SMITHTOWN NY
11787-2804
US

IV. Provider business mailing address

42 E MAIN ST
SMITHTOWN NY
11787-2804
US

V. Phone/Fax

Practice location:
  • Phone: 631-406-6611
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number006776
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: