Provider Demographics
NPI:1396839932
Name:KOWALSKY, KENNETH JOHN (PT)
Entity Type:Individual
Prefix:
First Name:KENNETH
Middle Name:JOHN
Last Name:KOWALSKY
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 1:5 FUNDY RD
Mailing Address - Street 2:
Mailing Address - City:FALMOUTH
Mailing Address - State:ME
Mailing Address - Zip Code:04105-1774
Mailing Address - Country:US
Mailing Address - Phone:207-781-8358
Mailing Address - Fax:207-781-8357
Practice Address - Street 1:5 FUNDY RD
Practice Address - Street 2:
Practice Address - City:FALMOUTH
Practice Address - State:ME
Practice Address - Zip Code:04105-1774
Practice Address - Country:US
Practice Address - Phone:207-781-8358
Practice Address - Fax:207-781-8357
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2010-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPT2105225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MEME1293Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER