Healthcare Provider Details

I. General information

NPI: 1710136478
Provider Name (Legal Business Name): LAURIE KOWALICK PT, OMPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/17/2008
Last Update Date: 05/22/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3100 CROSS CREEK PKWY STE 110
AUBURN HILLS MI
48326
US

IV. Provider business mailing address

3100 CROSS CREEK PKWY STE 110
AUBURN HILLS MI
48326-2775
US

V. Phone/Fax

Practice location:
  • Phone: 248-377-8000
  • Fax: 248-364-4265
Mailing address:
  • Phone: 248-377-8000
  • Fax: 248-364-4265

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License Number5501002313
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: