Healthcare Provider Details

I. General information

NPI: 1811020274
Provider Name (Legal Business Name): CAROL L KOWALSKI PT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/14/2007
Last Update Date: 06/25/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12 NEIL CT
OCEANSIDE NY
11572-5816
US

IV. Provider business mailing address

12 NEIL CT
OCEANSIDE NY
11572-5816
US

V. Phone/Fax

Practice location:
  • Phone: 516-766-1452
  • Fax:
Mailing address:
  • Phone: 516-766-1452
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number5501003699
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number031438
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: