Provider Demographics
NPI:1083861140
Name:KOWALINSKI, RUSSELL MARTIN (PT, DPT, SCS)
Entity Type:Individual
Prefix:
First Name:RUSSELL
Middle Name:MARTIN
Last Name:KOWALINSKI
Suffix:
Gender:M
Credentials:PT, DPT, SCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:451 DUVALL AVE NE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:RENTON
Mailing Address - State:WA
Mailing Address - Zip Code:98059-4675
Mailing Address - Country:US
Mailing Address - Phone:425-235-9505
Mailing Address - Fax:425-226-7334
Practice Address - Street 1:451 DUVALL AVE NE
Practice Address - Street 2:SUITE 200
Practice Address - City:RENTON
Practice Address - State:WA
Practice Address - Zip Code:98059-4675
Practice Address - Country:US
Practice Address - Phone:425-235-9505
Practice Address - Fax:425-226-7334
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-20
Last Update Date:2020-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT60028438225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist