Healthcare Provider Details

I. General information

NPI: 1851209266
Provider Name (Legal Business Name): BILLY COWGILL ATC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/28/2026
Last Update Date: 08/28/2026
Certification Date: 08/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1651 NAISMITH DR
LAWRENCE KS
66045-4069
US

IV. Provider business mailing address

524 N BLAZING STAR DR
LAWRENCE KS
66049-7823
US

V. Phone/Fax

Practice location:
  • Phone: 785-331-6611
  • Fax:
Mailing address:
  • Phone: 785-331-6611
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2081S0010X
TaxonomySports Medicine (Physical Medicine & Rehabilitation) Physician
License Number24-00454
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: