Provider Demographics
NPI:1285706945
Name:KOZEL, MARYANN
Entity type:Individual
Prefix:
First Name:MARYANN
Middle Name:
Last Name:KOZEL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:411 W ROAD 1 N
Mailing Address - Street 2:SUITE A
Mailing Address - City:CHINO VALLEY
Mailing Address - State:AZ
Mailing Address - Zip Code:86323-5943
Mailing Address - Country:US
Mailing Address - Phone:928-636-8591
Mailing Address - Fax:928-636-8591
Practice Address - Street 1:411 W ROAD 1 N
Practice Address - Street 2:SUITE A
Practice Address - City:CHINO VALLEY
Practice Address - State:AZ
Practice Address - Zip Code:86323-5943
Practice Address - Country:US
Practice Address - Phone:928-636-8591
Practice Address - Fax:928-636-8591
Is Sole Proprietor?:No
Enumeration Date:2006-11-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ6385225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist