Healthcare Provider Details

I. General information

NPI: 1548561855
Provider Name (Legal Business Name): ROBERT KOWALICK JR. PT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/03/2010
Last Update Date: 11/03/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2710 LEDGEWOOD CT
ROCHESTER MI
48306-2381
US

IV. Provider business mailing address

2710 LEDGEWOOD CT
ROCHESTER MI
48306-2381
US

V. Phone/Fax

Practice location:
  • Phone: 248-756-2300
  • Fax: 248-652-4695
Mailing address:
  • Phone: 248-756-2300
  • Fax: 248-652-4695

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number5501002335
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: