Healthcare Provider Details

I. General information

NPI: 1962720995
Provider Name (Legal Business Name): KURTIS COWAN RPT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/14/2010
Last Update Date: 05/14/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15055 W 87TH STREET PKWY
LENEXA KS
66215-5372
US

IV. Provider business mailing address

8438 MAURER RD APT 1311
LENEXA KS
66219-2781
US

V. Phone/Fax

Practice location:
  • Phone: 913-307-0665
  • Fax:
Mailing address:
  • Phone: 269-277-3271
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251G0304X
TaxonomyGeriatric Physical Therapist
License Number11-03772
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: