Provider Demographics
NPI:1558686717
Name:KOWAL, JOSEPH (PA)
Entity Type:Individual
Prefix:MR
First Name:JOSEPH
Middle Name:
Last Name:KOWAL
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:351 DOVER RD
Mailing Address - Street 2:SUITE B
Mailing Address - City:CLARKSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37042-4144
Mailing Address - Country:US
Mailing Address - Phone:931-905-1001
Mailing Address - Fax:931-905-0410
Practice Address - Street 1:351 DOVER RD
Practice Address - Street 2:SUITE B
Practice Address - City:CLARKSVILLE
Practice Address - State:TN
Practice Address - Zip Code:37042-4144
Practice Address - Country:US
Practice Address - Phone:931-905-1001
Practice Address - Fax:931-905-0410
Is Sole Proprietor?:No
Enumeration Date:2010-03-31
Last Update Date:2016-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN3084363AM0700X
TN3182225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant