Healthcare Provider Details

I. General information

NPI: 1356171755
Provider Name (Legal Business Name): CHELSEA MARIE KOZUB PT, DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/01/2024
Last Update Date: 09/09/2024
Certification Date: 09/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4850 E MAIN ST
COLUMBUS OH
43213-3194
US

IV. Provider business mailing address

160 W WILSON BRIDGE RD APT 329
WORTHINGTON OH
43085-2678
US

V. Phone/Fax

Practice location:
  • Phone: 614-897-0301
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT021358
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: