Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | PT35532 | CA |
N | 2251S0007X | Physical Therapist - Sports |
NPI | 1073144614 |
---|---|
Provider Name | Jonathan Koza |
First Address | Anderson, CA 96007-3279 |
Second Address | Anderson, CA 96007-3279 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/02/2020 |
Last Update Date | 02/02/2020 |