Healthcare Provider Details

I. General information

NPI: 1447982921
Provider Name (Legal Business Name): ANN KOWALSKI PT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/24/2022
Last Update Date: 06/24/2022
Certification Date: 06/19/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

26105 ORCHARD LAKE RD
FARMINGTON HILLS MI
48334-4576
US

IV. Provider business mailing address

1999 WINDINGWAY DR
WIXOM MI
48393-1151
US

V. Phone/Fax

Practice location:
  • Phone: 248-615-0852
  • Fax:
Mailing address:
  • Phone: 248-701-7819
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number5501005364
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: