Healthcare Provider Details

I. General information

NPI: 1023374089
Provider Name (Legal Business Name): KATIE L KOWALSKI PT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/04/2012
Last Update Date: 07/14/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

55 COBURG RD
EUGENE OR
97401-2433
US

IV. Provider business mailing address

55 COBURG RD
EUGENE OR
97401-2433
US

V. Phone/Fax

Practice location:
  • Phone: 541-485-8111
  • Fax: 541-868-0883
Mailing address:
  • Phone: 541-485-8111
  • Fax: 541-868-0883

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number06586
License Number StateOR

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier93-0603212
Identifier TypeOTHER
Identifier State
Identifier IssuerTAX ID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: