Provider Demographics
NPI:1891802583
Name:KOWASIC ENTERPRISES INCORPORATED
Entity Type:Organization
Organization Name:KOWASIC ENTERPRISES INCORPORATED
Other - Org Name:THE RIGHT STEP - HEALTHY FOOTWEAR
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VICE PRESIDENT/SECRETARY/SALES
Authorized Official - Prefix:MRS
Authorized Official - First Name:TRACY
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:KOWASIC
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:623-932-5505
Mailing Address - Street 1:1461 N DYSART RD
Mailing Address - Street 2:SUITE 103
Mailing Address - City:AVONDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85323-1538
Mailing Address - Country:US
Mailing Address - Phone:623-932-5505
Mailing Address - Fax:623-925-0752
Practice Address - Street 1:1461 N DYSART RD
Practice Address - Street 2:SUITE 103
Practice Address - City:AVONDALE
Practice Address - State:AZ
Practice Address - Zip Code:85323-1538
Practice Address - Country:US
Practice Address - Phone:623-932-5505
Practice Address - Fax:623-925-0752
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-25
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier