Basic Information
| Provider Information | |||||||||
| NPI: | 1770076069 | ||||||||
| EntityType: | 1 | ||||||||
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| LastName: | OWCZARSKI | ||||||||
| FirstName: | BRIAN | ||||||||
| MiddleName: | KRISTOFER | ||||||||
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| Mailing Information | |||||||||
| Address1: | 535 CENTERVILLE RD STE 101 | ||||||||
| Address2: | |||||||||
| City: | WARWICK | ||||||||
| State: | RI | ||||||||
| PostalCode: | 028864376 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4017376011 | ||||||||
| FaxNumber: | 4017374811 | ||||||||
| Practice Location | |||||||||
| Address1: | 80 STONINGTON RD STE A-3 | ||||||||
| Address2: | |||||||||
| City: | MYSTIC | ||||||||
| State: | CT | ||||||||
| PostalCode: | 06355 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8605361699 | ||||||||
| FaxNumber: | 8605361686 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/11/2018 | ||||||||
| LastUpdateDate: | 03/04/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 03/04/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 11916 | CT | N | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | 225100000X | PT03152 | RI | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.