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General NPI Number Information
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NPI Number | 1780162883
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Entity Type | Individual
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Provider Name | THERESA LYNN KOZIELL PT,MT
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Gender | Female
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Dates
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Enumeration Date | 07/31/2018
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Last Update Date | 07/31/2018
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Provider Practice Location Address
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Address Line | 133 STATE ST
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City | GUILFORD
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State | CT
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Zip | 06437-2471
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Country | US
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Telephone | 570-903-8153
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Fax | 203-453-2822
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Provider Business Mailing Address
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Address Line | 439 N RIVER STREET
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City | GUILFORD
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State | CT
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Zip | 06437-2430
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225700000X
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Taxonomy Name | Massage Therapist
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License Number | 10046
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License Number State | CT
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Taxonomy #2
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 006885
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License Number State | CT
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