Healthcare Provider Details

I. General information

NPI: 1457021529
Provider Name (Legal Business Name): NICOLE KOWALSKI PT, DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/20/2021
Last Update Date: 09/20/2021
Certification Date: 09/20/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11450 SPACE CENTER BLVD STE 201
HOUSTON TX
77059-3642
US

IV. Provider business mailing address

11450 SPACE CENTER BLVD STE 201
HOUSTON TX
77059-3642
US

V. Phone/Fax

Practice location:
  • Phone: 281-998-0901
  • Fax:
Mailing address:
  • Phone: 281-998-0901
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number3127946
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: