Healthcare Provider Details

I. General information

NPI: 1174598411
Provider Name (Legal Business Name): ANNE KOWALEFSKI PTA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ANNE WITZ PTA

II. Dates (important events)

Enumeration Date: 02/21/2006
Last Update Date: 02/13/2020
Certification Date: 02/13/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7800 N GREEN BAY RD
RIVER HILLS WI
53217-2047
US

IV. Provider business mailing address

N90W16660 ROOSEVELT DR
MENOMONEE FALLS WI
53051-2138
US

V. Phone/Fax

Practice location:
  • Phone: 414-255-1523
  • Fax:
Mailing address:
  • Phone: 262-573-0406
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number914-019
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: