Provider Demographics
NPI:1770984031
Name:MIKOWICZ, COURTNEY COLLINS (DPT)
Entity type:Individual
Prefix:
First Name:COURTNEY
Middle Name:COLLINS
Last Name:MIKOWICZ
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:COURTNEY
Other - Middle Name:ELIZABETH
Other - Last Name:COLLINS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5 DIABLO VIEW CT
Mailing Address - Street 2:
Mailing Address - City:DANVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:94506-6150
Mailing Address - Country:US
Mailing Address - Phone:925-451-0426
Mailing Address - Fax:
Practice Address - Street 1:3222 GEARY BLVD
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94118-3319
Practice Address - Country:US
Practice Address - Phone:415-831-4658
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-09-05
Last Update Date:2019-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ06873ZMedicare PIN
CACA190526Medicare PIN