Provider Demographics
NPI:1578190427
Name:KOWALCZYK, MEREDITH MILLER (PT, DPT)
Entity Type:Individual
Prefix:
First Name:MEREDITH
Middle Name:MILLER
Last Name:KOWALCZYK
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:MEREDITH
Other - Middle Name:ANNE
Other - Last Name:MILLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:550 CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:NEW PROVIDENCE
Mailing Address - State:NJ
Mailing Address - Zip Code:07974-1505
Mailing Address - Country:US
Mailing Address - Phone:908-522-2215
Mailing Address - Fax:
Practice Address - Street 1:550 CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:NEW PROVIDENCE
Practice Address - State:NJ
Practice Address - Zip Code:07974-1505
Practice Address - Country:US
Practice Address - Phone:908-522-2215
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-03-23
Last Update Date:2020-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA015793002251N0400X, 225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2251N0400XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistNeurology