Provider Demographics
NPI:1114233186
Name:SOWINSKI, CASEY JOSEPH (PT)
Entity Type:Individual
Prefix:MR
First Name:CASEY
Middle Name:JOSEPH
Last Name:SOWINSKI
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4884 GRATIOT RD STE 19
Mailing Address - Street 2:
Mailing Address - City:SAGINAW
Mailing Address - State:MI
Mailing Address - Zip Code:48638-6270
Mailing Address - Country:US
Mailing Address - Phone:989-799-9150
Mailing Address - Fax:989-799-9153
Practice Address - Street 1:4884 GRATIOT RD STE 19
Practice Address - Street 2:
Practice Address - City:SAGINAW
Practice Address - State:MI
Practice Address - Zip Code:48638-6270
Practice Address - Country:US
Practice Address - Phone:989-799-9150
Practice Address - Fax:989-799-9153
Is Sole Proprietor?:No
Enumeration Date:2010-08-27
Last Update Date:2011-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501015322225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
P22210008Medicare PIN