Healthcare Provider Details

I. General information

NPI: 1932565405
Provider Name (Legal Business Name): POLINA V KOZLOWSKI LMT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/13/2016
Last Update Date: 07/15/2026
Certification Date: 07/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1306 WILMINGTON PIKE STE C
WEST CHESTER PA
19382-8270
US

IV. Provider business mailing address

1306 WILMINGTON PIKE STE C ROOM #1
WEST CHESTER PA
19382
US

V. Phone/Fax

Practice location:
  • Phone: 484-317-4377
  • Fax:
Mailing address:
  • Phone: 484-317-4377
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberSP020320
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN639988
License Number StatePA
# 3
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMSG003861
License Number StatePA
# 4
Primary TaxonomyN
Taxonomy Code163WM1400X
TaxonomyNurse Massage Therapist (NMT)
License NumberRN639988
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: