Provider Demographics
NPI:1720087679
Name:KOZLOWSKI, ERIKA M (PT)
Entity type:Individual
Prefix:
First Name:ERIKA
Middle Name:M
Last Name:KOZLOWSKI
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:ERIKA
Other - Middle Name:
Other - Last Name:FALLON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2655 RIDGEWAY AVE
Mailing Address - Street 2:SUITE 320
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14626-4296
Mailing Address - Country:US
Mailing Address - Phone:585-368-6600
Mailing Address - Fax:585-368-6601
Practice Address - Street 1:2655 RIDGEWAY AVE
Practice Address - Street 2:SUITE 320
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14626-4296
Practice Address - Country:US
Practice Address - Phone:585-368-6600
Practice Address - Fax:585-368-6601
Is Sole Proprietor?:No
Enumeration Date:2005-07-21
Last Update Date:2015-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY014176225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYCC7586Medicare ID - Type Unspecified