Healthcare Provider Details

I. General information

NPI: 1558842310
Provider Name (Legal Business Name): ELIZABETH KOCHANOWSKI DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/28/2018
Last Update Date: 08/01/2022
Certification Date: 08/01/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

746 W GUADALUPE RD
GILBERT AZ
85233-3200
US

IV. Provider business mailing address

13625 S 48TH ST APT 1118
PHOENIX AZ
85044-5051
US

V. Phone/Fax

Practice location:
  • Phone: 480-645-9310
  • Fax:
Mailing address:
  • Phone: 860-734-3036
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number11925
License Number StateCT
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberLPT-31032
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: