Provider Demographics
NPI:1831214840
Name:KOZDRAS, FRANK JOHN (LMT)
Entity type:Individual
Prefix:MR
First Name:FRANK
Middle Name:JOHN
Last Name:KOZDRAS
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:210 WOOD ST
Mailing Address - Street 2:
Mailing Address - City:PUNTA GORDA
Mailing Address - State:FL
Mailing Address - Zip Code:33950-3845
Mailing Address - Country:US
Mailing Address - Phone:941-833-5717
Mailing Address - Fax:941-833-5715
Practice Address - Street 1:27373 SAN MARCO DR
Practice Address - Street 2:
Practice Address - City:PUNTA GORDA
Practice Address - State:FL
Practice Address - Zip Code:33983-8749
Practice Address - Country:US
Practice Address - Phone:941-380-0330
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA29367225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist