Provider Demographics
NPI:1548561855
Name:KOWALICK, ROBERT JR (PT)
Entity Type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:
Last Name:KOWALICK
Suffix:JR
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 1:2710 LEDGEWOOD CT
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:MI
Mailing Address - Zip Code:48306-2381
Mailing Address - Country:US
Mailing Address - Phone:248-756-2300
Mailing Address - Fax:248-652-4695
Practice Address - Street 1:2710 LEDGEWOOD CT
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:MI
Practice Address - Zip Code:48306-2381
Practice Address - Country:US
Practice Address - Phone:248-756-2300
Practice Address - Fax:248-652-4695
Is Sole Proprietor?:No
Enumeration Date:2010-11-03
Last Update Date:2010-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501002335225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist