Healthcare Provider Details

I. General information

NPI: 1093214850
Provider Name (Legal Business Name): ROBERT COWLEY PT, DPT, OCS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/07/2018
Last Update Date: 10/25/2022
Certification Date: 10/25/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12731 MARBLESTONE DR STE 202
WOODBRIDGE VA
22192-8334
US

IV. Provider business mailing address

12544 DILLINGHAM SQ
WOODBRIDGE VA
22192-5259
US

V. Phone/Fax

Practice location:
  • Phone: 571-659-2612
  • Fax: 571-659-2619
Mailing address:
  • Phone: 703-730-6969
  • Fax: 703-730-1169

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number2305211753
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: