Healthcare Provider Details

I. General information

NPI: 1558842104
Provider Name (Legal Business Name): VICTORIA KOWALEWSKI
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/22/2018
Last Update Date: 05/24/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

801 W ANN ARBOR TRL STE 220
PLYMOUTH MI
48170-6224
US

IV. Provider business mailing address

801 W ANN ARBOR TRL STE 220
PLYMOUTH MI
48170-6224
US

V. Phone/Fax

Practice location:
  • Phone: 866-991-0900
  • Fax:
Mailing address:
  • Phone: 866-991-0900
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberCP000165T
License Number StateNH
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT5350
License Number StateNM
# 3
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number1274666
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: