Provider Demographics
NPI:1124332341
Name:COZBY, NICOLE MARIE VANDEVELDE (PT, DPT)
Entity type:Individual
Prefix:MS
First Name:NICOLE
Middle Name:MARIE VANDEVELDE
Last Name:COZBY
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:NICOLE
Other - Middle Name:MARIE
Other - Last Name:VANDEVELDE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT,DPT
Mailing Address - Street 1:1605 HOPE ST
Mailing Address - Street 2:STE 100
Mailing Address - City:SOUTH PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91030-2647
Mailing Address - Country:US
Mailing Address - Phone:818-731-3447
Mailing Address - Fax:626-737-6736
Practice Address - Street 1:1605 HOPE ST
Practice Address - Street 2:SUITE 100
Practice Address - City:SOUTH PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91030-2628
Practice Address - Country:US
Practice Address - Phone:818-731-3447
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-07-29
Last Update Date:2021-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT36827225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist