Provider Demographics
NPI:1316596638
Name:KOWALCZYK, KATHERINE A (PT, DPT)
Entity type:Individual
Prefix:DR
First Name:KATHERINE
Middle Name:A
Last Name:KOWALCZYK
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:DR
Other - First Name:KATIE
Other - Middle Name:A
Other - Last Name:KOWALCZYK
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PT, DPT
Mailing Address - Street 1:65 E WADSWORTH PARK DR STE 230
Mailing Address - Street 2:
Mailing Address - City:DRAPER
Mailing Address - State:UT
Mailing Address - Zip Code:84020-8096
Mailing Address - Country:US
Mailing Address - Phone:853-308-8034
Mailing Address - Fax:808-657-3222
Practice Address - Street 1:131 RACINE DR STE 201
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28403-8752
Practice Address - Country:US
Practice Address - Phone:910-362-9405
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-09
Last Update Date:2025-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT35121208100000X, 225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Single Specialty