Provider Demographics
NPI:1710136478
Name:KOWALICK, LAURIE (PT, OMPT)
Entity Type:Individual
Prefix:
First Name:LAURIE
Middle Name:
Last Name:KOWALICK
Suffix:
Gender:F
Credentials:PT, OMPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3100 CROSS CREEK PKWY STE 110
Mailing Address - Street 2:
Mailing Address - City:AUBURN HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48326-2775
Mailing Address - Country:US
Mailing Address - Phone:248-377-8000
Mailing Address - Fax:248-364-4265
Practice Address - Street 1:3100 CROSS CREEK PKWY STE 110
Practice Address - Street 2:
Practice Address - City:AUBURN HILLS
Practice Address - State:MI
Practice Address - Zip Code:48326
Practice Address - Country:US
Practice Address - Phone:248-377-8000
Practice Address - Fax:248-364-4265
Is Sole Proprietor?:No
Enumeration Date:2008-09-17
Last Update Date:2018-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI55010023132251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic