Healthcare Provider Details

I. General information

NPI: 1821434952
Provider Name (Legal Business Name): BENJAMIN KOWATCH DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/15/2013
Last Update Date: 05/15/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1307 FEDERAL ST
PITTSBURGH PA
15212-4769
US

IV. Provider business mailing address

151 DEL RIO DR
PITTSBURGH PA
15236-2014
US

V. Phone/Fax

Practice location:
  • Phone: 412-359-4646
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT022026
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: