Healthcare Provider Details

I. General information

NPI: 1417011834
Provider Name (Legal Business Name): LUCYNA ZOFIA KOWALCZYK PTA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/20/2006
Last Update Date: 09/17/2024
Certification Date: 09/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12040 NE 128TH ST
KIRKLAND WA
98034-3013
US

IV. Provider business mailing address

15430 SE 67TH PL
BELLEVUE WA
98006-5418
US

V. Phone/Fax

Practice location:
  • Phone: 425-449-3429
  • Fax:
Mailing address:
  • Phone: 425-401-9105
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License NumberP1-60031745
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: