Provider Demographics
NPI:1063649218
Name:COWELL, LUKE HENRY (PTA)
Entity Type:Individual
Prefix:
First Name:LUKE
Middle Name:HENRY
Last Name:COWELL
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1102 SHADY LN
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MO
Mailing Address - Zip Code:63755-2652
Mailing Address - Country:US
Mailing Address - Phone:573-275-0711
Mailing Address - Fax:
Practice Address - Street 1:1102 SHADY LN
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MO
Practice Address - Zip Code:63755-2652
Practice Address - Country:US
Practice Address - Phone:573-275-0711
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-15
Last Update Date:2009-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2000166666225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant