Basic Information
| Provider Information | |||||||||
| NPI: | 1780946202 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HOWARD | ||||||||
| FirstName: | NATALIE | ||||||||
| MiddleName: | KOZICKI | ||||||||
| NamePrefix: | MS. | ||||||||
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| Credential: | MSPT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3826 44TH ST SE | ||||||||
| Address2: | |||||||||
| City: | KENTWOOD | ||||||||
| State: | MI | ||||||||
| PostalCode: | 495123919 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6165540918 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 3826 44TH ST SE | ||||||||
| Address2: | |||||||||
| City: | KENTWOOD | ||||||||
| State: | MI | ||||||||
| PostalCode: | 49512 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6165540918 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/11/2012 | ||||||||
| LastUpdateDate: | 07/23/2018 | ||||||||
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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 | 174400000X | 5501008419 | MI | N | Other Service Providers | Specialist | 225100000X | 5501008419 | MI | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.