Provider Demographics
NPI:1154693760
Name:KOZAK, MARYANNE MARGARET (PT)
Entity type:Individual
Prefix:MRS
First Name:MARYANNE
Middle Name:MARGARET
Last Name:KOZAK
Suffix:
Gender:F
Credentials:PT
Other - Prefix:MRS
Other - First Name:MARYANNE
Other - Middle Name:MARGARET
Other - Last Name:GILBERT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:600 REISTERSTOWN RD
Mailing Address - Street 2:SUITE 210
Mailing Address - City:PIKESVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21208-5105
Mailing Address - Country:US
Mailing Address - Phone:410-415-5374
Mailing Address - Fax:410-415-5375
Practice Address - Street 1:600 REISTERSTOWN RD
Practice Address - Street 2:SUITE 210
Practice Address - City:PIKESVILLE
Practice Address - State:MD
Practice Address - Zip Code:21208-5105
Practice Address - Country:US
Practice Address - Phone:410-415-5374
Practice Address - Fax:410-415-5375
Is Sole Proprietor?:No
Enumeration Date:2012-01-30
Last Update Date:2012-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD21257225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist