Basic Information
| Provider Information | |||||||||
| NPI: | 1588786958 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | KOZLEK | ||||||||
| FirstName: | KRISTY | ||||||||
| MiddleName: | MARIE | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1623 MORGANTOWN RD | ||||||||
| Address2: | |||||||||
| City: | READING | ||||||||
| State: | PA | ||||||||
| PostalCode: | 196079455 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6107966364 | ||||||||
| FaxNumber: | 6107966470 | ||||||||
| Practice Location | |||||||||
| Address1: | 1623 MORGANTOWN RD | ||||||||
| Address2: | |||||||||
| City: | READING | ||||||||
| State: | PA | ||||||||
| PostalCode: | 196079455 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6107966364 | ||||||||
| FaxNumber: | 6107966470 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/04/2007 | ||||||||
| LastUpdateDate: | 06/30/2010 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208100000X | MT189420 | PA | N | Allopathic & Osteopathic Physicians | Physical Medicine & Rehabilitation | 208100000X | MD436512 | PA | Y | Allopathic & Osteopathic Physicians | Physical Medicine & Rehabilitation |
ID Information
| ID | Type | State | Issuer | Description | 1023295710001 | 05 | PA | MEDICAID |