MEDICARE: JEAN KOZEMPEL PT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	PT006669L	PA

General Provider Information

NPI Number	:	1124072178
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JEAN KOZEMPEL PT

Provider Business Mailing Address
First Line	:	2730 WILLITS RD
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19152-1646
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2835 TYSON AVE
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19149-1415
Country	:	US
Telephone Number	:	215-624-1080
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/22/2006
Last Update Date	:	07/08/2007

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