Healthcare Provider Details

I. General information

NPI: 1194380477
Provider Name (Legal Business Name): BRIAN JOSEPH KOWAL DPT, PT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/02/2019
Last Update Date: 12/13/2021
Certification Date: 12/13/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2230 N RIDGE RD
WICHITA KS
67205-1053
US

IV. Provider business mailing address

2230 N RIDGE RD
WICHITA KS
67205-1053
US

V. Phone/Fax

Practice location:
  • Phone: 316-448-8339
  • Fax: 316-221-7149
Mailing address:
  • Phone: 316-448-8339
  • Fax: 316-221-7149

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: