Basic Information
| Provider Information | |||||||||
| NPI: | 1073833646 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | KOZLEK PHYSIATRY SPECIALISTS, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1623 MORGANTOWN RD | ||||||||
| Address2: | |||||||||
| City: | READING | ||||||||
| State: | PA | ||||||||
| PostalCode: | 196079455 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6107966364 | ||||||||
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| Address1: | 1623 MORGANTOWN RD | ||||||||
| Address2: | |||||||||
| City: | READING | ||||||||
| State: | PA | ||||||||
| PostalCode: | 196079455 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6107966364 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/07/2010 | ||||||||
| LastUpdateDate: | 06/07/2010 | ||||||||
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| AuthorizedOfficialLastName: | KOZLEK | ||||||||
| AuthorizedOfficialFirstName: | KRISTY | ||||||||
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| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 6107966364 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208100000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Physical Medicine & Rehabilitation |
No ID Information.