Individual
KELLY JEAN NOWACKI
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
P.T.
Contact information
Practice address
720 9TH AVE MAWSECO, HOWARD LAKE, MN 55349
(320) 543-1122
(952) 476-0218
Mailing address
14339 DUFFIELD AVE, NW, MONTICELLO, MN 55362
(763) 682-5168
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
7213
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
044955500
—
MN
Enumeration date
07/19/2006
Last updated
05/14/2026
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