Provider Demographics
NPI:1578914693
Name:KOWALCZYK, AMY SARA (ATC)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:SARA
Last Name:KOWALCZYK
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:419 S RIVER ST
Mailing Address - Street 2:
Mailing Address - City:WILKES BARRE
Mailing Address - State:PA
Mailing Address - Zip Code:18702-3706
Mailing Address - Country:US
Mailing Address - Phone:570-905-1325
Mailing Address - Fax:
Practice Address - Street 1:419 S RIVER ST
Practice Address - Street 2:
Practice Address - City:WILKES BARRE
Practice Address - State:PA
Practice Address - Zip Code:18702-3706
Practice Address - Country:US
Practice Address - Phone:570-905-1325
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-06-30
Last Update Date:2016-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer