Healthcare Provider Details

I. General information

NPI: 1235522657
Provider Name (Legal Business Name): KATELYN KARBOWSKI PT, DPT, ATC/L
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/10/2015
Last Update Date: 08/11/2020
Certification Date: 08/11/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2001 CHURCH LN
VILLA RICA GA
30180-4720
US

IV. Provider business mailing address

790 REMINGTON BOULEVARD
BOLINGBROOK IL
60440
US

V. Phone/Fax

Practice location:
  • Phone: 770-459-6533
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT014798
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License NumberAT003315
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: