Healthcare Provider Details

I. General information

NPI: 1225313158
Provider Name (Legal Business Name): JEFFREY J. KOZLIK PT, DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/11/2011
Last Update Date: 10/11/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

120 CENTERVILLE RD PHYSICAL THERAPY DEPARTMENT
WARWICK RI
02886-4336
US

IV. Provider business mailing address

120 CENTERVILLE RD PHYSICAL THERAPY DEPARTMENT
WARWICK RI
02886-4336
US

V. Phone/Fax

Practice location:
  • Phone: 401-738-7347
  • Fax:
Mailing address:
  • Phone: 401-738-7347
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License NumberPT01291
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: