MEDICARE: MR. GREGORY S KOWAL DPT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	PT021210	PA

General Provider Information

NPI Number	:	1114200383
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. GREGORY S KOWAL DPT

Provider Business Mailing Address
First Line	:	PO BOX 34990
Second Line	:
City	:	BELFAST
State	:	ME
Zip	:	04915-0627
Country	:	US
Telephone Number	:	610-359-5640
Fax Number	:	833-941-3871

Provider Business Practice Location Address
First Line	:	501 MACDADE BLVD FL 2
Second Line	:
City	:	FOLSOM
State	:	PA
Zip	:	19033-3224
Country	:	US
Telephone Number	:	610-586-7000
Fax Number	:	833-941-3871

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/23/2011
Last Update Date	:	02/24/2026

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