MEDICARE: MS. MARY ELIZABETH KOWALSKI X ATC

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	171W00000X	Contractor	RT000718B	PA

General Provider Information

NPI Number	:	1972056976
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. MARY ELIZABETH KOWALSKI X ATC

Provider Business Mailing Address
First Line	:	3200 PLEASANT VALLEY BLVD
Second Line	:
City	:	ALTOONA
State	:	PA
Zip	:	16602-4310
Country	:	US
Telephone Number	:	814-949-9500
Fax Number	:	814-949-9550

Provider Business Practice Location Address
First Line	:	3519 SCOTCH VALLEY RD # 2
Second Line	:
City	:	HOLLIDAYSBURG
State	:	PA
Zip	:	16648-5275
Country	:	US
Telephone Number	:	814-934-4793
Fax Number	:

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

Provider Enumeration Date	:	07/27/2016
Last Update Date	:	07/27/2016

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