Healthcare Provider Details

I. General information

NPI: 1477740173
Provider Name (Legal Business Name): CHRISTINE M KOWALCHUK PT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/27/2007
Last Update Date: 09/27/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 S BRYN MAWR AVE SUITE 200
BRYN MAWR PA
19010-3120
US

IV. Provider business mailing address

101 S BRYN MAWR AVE SUITE 200
BRYN MAWR PA
19010-3120
US

V. Phone/Fax

Practice location:
  • Phone: 610-527-9500
  • Fax: 610-527-9529
Mailing address:
  • Phone: 610-527-9500
  • Fax: 610-527-9529

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT018903
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: