Provider Demographics
NPI:1023373560
Name:COWEN, JEFFREY BLAINE (DPT)
Entity Type:Individual
Prefix:
First Name:JEFFREY
Middle Name:BLAINE
Last Name:COWEN
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1500 GRAND CENTRAL AVE
Mailing Address - Street 2:SUITE 101
Mailing Address - City:VIENNA
Mailing Address - State:WV
Mailing Address - Zip Code:26105-1079
Mailing Address - Country:US
Mailing Address - Phone:304-295-3060
Mailing Address - Fax:304-295-3068
Practice Address - Street 1:932 E STATE ST STE 102
Practice Address - Street 2:
Practice Address - City:ATHENS
Practice Address - State:OH
Practice Address - Zip Code:45701-2116
Practice Address - Country:US
Practice Address - Phone:740-592-3778
Practice Address - Fax:740-592-3790
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-11
Last Update Date:2023-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPT013813225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist