Healthcare Provider Details

I. General information

NPI: 1699277517
Provider Name (Legal Business Name): TINA KOWALSKI
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/07/2018
Last Update Date: 03/07/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25911 MIDDLEBELT RD
FARMINGTON HILLS MI
48336-1402
US

IV. Provider business mailing address

21340 LARKSPUR ST
FARMINGTON MI
48336-5048
US

V. Phone/Fax

Practice location:
  • Phone: 248-471-9580
  • Fax: 248-471-9580
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: