Healthcare Provider Details

I. General information

NPI: 1639268162
Provider Name (Legal Business Name): ROBERT KOWALSKI PT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/12/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4400 US HIGHWAY 9
FREEHOLD NJ
07728-1383
US

IV. Provider business mailing address

302 BRINLEY AVE
BRADLEY BEACH NJ
07720-1308
US

V. Phone/Fax

Practice location:
  • Phone: 732-493-3624
  • Fax:
Mailing address:
  • Phone: 732-599-2550
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number40QA00726300
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: