MEDICARE: ANNE KOWALEFSKI PTA

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	225200000X	Physical Therapy Assistant	914-019	WI

General Provider Information

NPI Number	:	1174598411
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANNE KOWALEFSKI PTA

Provider Business Mailing Address
First Line	:	N90W16660 ROOSEVELT DR
Second Line	:
City	:	MENOMONEE FALLS
State	:	WI
Zip	:	53051-2138
Country	:	US
Telephone Number	:	262-573-0406
Fax Number	:

Provider Business Practice Location Address
First Line	:	7800 N GREEN BAY RD
Second Line	:
City	:	RIVER HILLS
State	:	WI
Zip	:	53217-2047
Country	:	US
Telephone Number	:	414-255-1523
Fax Number	:

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

Provider Enumeration Date	:	02/21/2006
Last Update Date	:	02/13/2020

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