Provider Demographics
NPI:1104874726
Name:SOWA, JULIE PATRICIA (PT)
Entity type:Individual
Prefix:MS
First Name:JULIE
Middle Name:PATRICIA
Last Name:SOWA
Suffix:
Gender:F
Credentials:PT
Other - Prefix:MS
Other - First Name:JULIE
Other - Middle Name:PATRICIA
Other - Last Name:KWIECINSKI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:4726 WOODLAND BROOK CT SE
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30339-1572
Mailing Address - Country:US
Mailing Address - Phone:122-567-3573
Mailing Address - Fax:
Practice Address - Street 1:47100 SCHOENHERR RD
Practice Address - Street 2:SUITE E
Practice Address - City:SHELBY TOWNSHIP
Practice Address - State:MI
Practice Address - Zip Code:48315-4716
Practice Address - Country:US
Practice Address - Phone:586-685-0505
Practice Address - Fax:586-685-0501
Is Sole Proprietor?:No
Enumeration Date:2006-05-05
Last Update Date:2022-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501300547225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist