Healthcare Provider Details

I. General information

NPI: 1215804836
Provider Name (Legal Business Name): DAVID KOWALSKI
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/20/2025
Last Update Date: 10/20/2025
Certification Date: 10/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7529 SAN JOSE BLVD
JACKSONVILLE FL
32217-3524
US

IV. Provider business mailing address

1334 INWOOD TER
JACKSONVILLE FL
32207-4259
US

V. Phone/Fax

Practice location:
  • Phone: 609-425-5982
  • Fax:
Mailing address:
  • Phone: 609-425-5982
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number41388
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: