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General NPI Number Information
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NPI Number | 1750757092
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Entity Type | Individual
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Provider Name | COWAN BROWN DPT
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Gender | Male
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Dates
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Enumeration Date | 08/20/2015
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Last Update Date | 12/13/2019
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Provider Practice Location Address
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Address Line | 4300 LINCOLN AVE UNIT B
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City | LISLE
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State | IL
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Zip | 60532-1210
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Country | US
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Telephone | 630-281-2900
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Fax | 630-281-2901
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Provider Business Mailing Address
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Address Line | 33900 HARPER AVE STE 104
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City | CLINTON TWP
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State | MI
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Zip | 48035-4258
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Country | US
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Telephone | 586-350-2644
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Fax | 586-541-3735
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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 | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 070021633
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License Number State | IL
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