Healthcare Provider Details

I. General information

NPI: 1316596638
Provider Name (Legal Business Name): KATHERINE A KOWALCZYK PT, DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: KATIE A KOWALCZYK PT, DPT

II. Dates (important events)

Enumeration Date: 09/09/2019
Last Update Date: 12/08/2025
Certification Date: 12/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

131 RACINE DR STE 201
WILMINGTON NC
28403-8752
US

IV. Provider business mailing address

65 E WADSWORTH PARK DR STE 230
DRAPER UT
84020-8096
US

V. Phone/Fax

Practice location:
  • Phone: 910-362-9405
  • Fax:
Mailing address:
  • Phone: 853-308-8034
  • Fax: 808-657-3222

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License NumberPT35121
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT35121
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: