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General NPI Number Information
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NPI Number | 1750756516
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Entity Type | Individual
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Provider Name | THEODORE COWLING ATC
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Gender | Male
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Dates
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Enumeration Date | 12/04/2015
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Last Update Date | 12/04/2015
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Provider Practice Location Address
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Address Line | 400 S ORANGE AVE
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City | SOUTH ORANGE
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State | NJ
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Zip | 07079-2646
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Country | US
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Telephone | 973-275-2510
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Fax |
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Provider Business Mailing Address
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Address Line | 1287 KENNEDY RD
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City | STREETSBORO
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State | OH
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Zip | 44241-5848
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Country | US
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Telephone | 330-819-0279
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number | 25MT00200400
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License Number State | NJ
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