Provider Demographics
NPI:1235404948
Name:NOWKA, KRISTINA K (AT, PTA)
Entity Type:Individual
Prefix:
First Name:KRISTINA
Middle Name:K
Last Name:NOWKA
Suffix:
Gender:F
Credentials:AT, PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:208 BRIDGE ST
Mailing Address - Street 2:
Mailing Address - City:EAST JORDAN
Mailing Address - State:MI
Mailing Address - Zip Code:49727-9318
Mailing Address - Country:US
Mailing Address - Phone:989-996-1098
Mailing Address - Fax:
Practice Address - Street 1:208 BRIDGE ST
Practice Address - Street 2:
Practice Address - City:EAST JORDAN
Practice Address - State:MI
Practice Address - Zip Code:49727-9318
Practice Address - Country:US
Practice Address - Phone:989-996-1098
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-03-13
Last Update Date:2020-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5502004407225200000X
MI26010007352255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer