Healthcare Provider Details

I. General information

NPI: 1720656697
Provider Name (Legal Business Name): MACKENZIE LYNN KOWALICK DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/16/2021
Last Update Date: 12/08/2023
Certification Date: 12/08/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1585 MID VALLEY DR STE 3
STEAMBOAT SPRINGS CO
80487-9099
US

IV. Provider business mailing address

1585 MID VALLEY DR STE 3
STEAMBOAT SPRINGS CO
80487-9099
US

V. Phone/Fax

Practice location:
  • Phone: 970-879-8026
  • Fax:
Mailing address:
  • Phone: 970-879-8026
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License Number0017722
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: