Healthcare Provider Details

I. General information

NPI: 1386063246
Provider Name (Legal Business Name): DANIELA MARIA KOWAL PT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: DANIELA MARIA KOWAL PT

II. Dates (important events)

Enumeration Date: 04/08/2014
Last Update Date: 04/08/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17 LANSING ST
AUBURN NY
13021-1983
US

IV. Provider business mailing address

17 LANSING ST
AUBURN NY
13021-1983
US

V. Phone/Fax

Practice location:
  • Phone: 315-255-7011
  • Fax: 315-255-7051
Mailing address:
  • Phone: 315-255-7011
  • Fax: 315-255-7051

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number015469-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: