Provider Demographics
NPI:1366882672
Name:JOZIC, MCKENZI R (DPT)
Entity type:Individual
Prefix:DR
First Name:MCKENZI
Middle Name:R
Last Name:JOZIC
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:DR
Other - First Name:MCKENZI
Other - Middle Name:R
Other - Last Name:VANFOSSEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:PO BOX 33396
Mailing Address - Street 2:
Mailing Address - City:N ROYALTON
Mailing Address - State:OH
Mailing Address - Zip Code:44133-0396
Mailing Address - Country:US
Mailing Address - Phone:440-230-1133
Mailing Address - Fax:440-230-9243
Practice Address - Street 1:2607 WYOMING BLVD NE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87112-1029
Practice Address - Country:US
Practice Address - Phone:505-296-9521
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-07-01
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPT014260225100000X
NM5149225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHH213850Medicare PIN
OHH213851Medicare PIN
OHH213852Medicare PIN
OHH213853Medicare PIN