Healthcare Provider Details

I. General information

NPI: 1720222797
Provider Name (Legal Business Name): KAREN BATT KOWALCZYK PT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/22/2009
Last Update Date: 04/22/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

94 JOHN ST
QUEENSBURY NY
12804-8412
US

IV. Provider business mailing address

PO BOX 4103
QUEENSBURY NY
12804-0103
US

V. Phone/Fax

Practice location:
  • Phone: 518-361-2864
  • Fax:
Mailing address:
  • Phone: 518-361-2864
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number014626-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: