Provider Demographics
NPI:1316700412
Name:KOWALSKI, CASEY ALLENE (PT, DPT)
Entity type:Individual
Prefix:DR
First Name:CASEY
Middle Name:ALLENE
Last Name:KOWALSKI
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:CASEY
Other - Middle Name:ALLENE
Other - Last Name:BERBERICH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:9805 NORBY LN
Mailing Address - Street 2:
Mailing Address - City:LEBANON
Mailing Address - State:IL
Mailing Address - Zip Code:62254-2316
Mailing Address - Country:US
Mailing Address - Phone:618-960-7911
Mailing Address - Fax:
Practice Address - Street 1:101 S BELT W
Practice Address - Street 2:
Practice Address - City:BELLEVILLE
Practice Address - State:IL
Practice Address - Zip Code:62220-2503
Practice Address - Country:US
Practice Address - Phone:618-277-7700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-02-01
Last Update Date:2024-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist