Healthcare Provider Details

I. General information

NPI: 1578885190
Provider Name (Legal Business Name): DONNA BENOY KOWALSKI LMBT, MMP, CPMT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/23/2010
Last Update Date: 09/26/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

212 W SECOND AVE SUITE A
GASTONIA NC
28052-4055
US

IV. Provider business mailing address

PO BOX 294
DALLAS NC
28034-0294
US

V. Phone/Fax

Practice location:
  • Phone: 704-813-0462
  • Fax:
Mailing address:
  • Phone: 704-915-5353
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number9739
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: