Provider Demographics
NPI:1417011834
Name:KOWALCZYK, LUCY Z (PTA)
Entity Type:Individual
Prefix:
First Name:LUCY
Middle Name:Z
Last Name:KOWALCZYK
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15430 SE 67TH PL
Mailing Address - Street 2:
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98006-5418
Mailing Address - Country:US
Mailing Address - Phone:425-401-9105
Mailing Address - Fax:
Practice Address - Street 1:12844 MILITARY RD S
Practice Address - Street 2:
Practice Address - City:TUKWILA
Practice Address - State:WA
Practice Address - Zip Code:98168-3045
Practice Address - Country:US
Practice Address - Phone:206-439-9095
Practice Address - Fax:206-433-1031
Is Sole Proprietor?:No
Enumeration Date:2006-12-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant