Healthcare Provider Details

I. General information

NPI: 1710762844
Provider Name (Legal Business Name): SHERRY LIN KOWAL
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/28/2023
Last Update Date: 08/28/2023
Certification Date: 08/28/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8469 S SAGINAW ST
GRAND BLANC MI
48439-2069
US

IV. Provider business mailing address

1411 ROLLINS ST
GRAND BLANC MI
48439-5176
US

V. Phone/Fax

Practice location:
  • Phone: 989-205-9255
  • Fax:
Mailing address:
  • Phone: 989-205-9255
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number7501002908
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: