Basic Information
| Provider Information | |||||||||
| NPI: | 1588670483 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | KOZLOWSKI | ||||||||
| FirstName: | JOSEPH | ||||||||
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| Credential: | MSPT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 513 NW FIR AVE | ||||||||
| Address2: | |||||||||
| City: | REDMOND | ||||||||
| State: | OR | ||||||||
| PostalCode: | 977561550 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5419230410 | ||||||||
| FaxNumber: | 5419237393 | ||||||||
| Practice Location | |||||||||
| Address1: | 513 NW FIR AVE | ||||||||
| Address2: | |||||||||
| City: | REDMOND | ||||||||
| State: | OR | ||||||||
| PostalCode: | 977561550 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5419230410 | ||||||||
| FaxNumber: | 5419237393 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/31/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 4432 | OR | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
ID Information
| ID | Type | State | Issuer | Description | P00240308 | 01 | OR | RR MEDI | OTHER |