Provider Demographics
NPI:1639268162
Name:KOWALSKI, ROBERT (PT)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:
Last Name:KOWALSKI
Suffix:
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 1:302 BRINLEY AVE
Mailing Address - Street 2:
Mailing Address - City:BRADLEY BEACH
Mailing Address - State:NJ
Mailing Address - Zip Code:07720-1308
Mailing Address - Country:US
Mailing Address - Phone:732-599-2550
Mailing Address - Fax:
Practice Address - Street 1:4400 US HIGHWAY 9
Practice Address - Street 2:
Practice Address - City:FREEHOLD
Practice Address - State:NJ
Practice Address - Zip Code:07728-1383
Practice Address - Country:US
Practice Address - Phone:732-493-3624
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA00726300225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist