Provider Demographics
NPI:1083342687
Name:COWAN, DYANDRA JANE (LMT)
Entity Type:Individual
Prefix:MS
First Name:DYANDRA
Middle Name:JANE
Last Name:COWAN
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:251 SPRINGDALE AVE
Mailing Address - Street 2:
Mailing Address - City:EAST ORANGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07017-4512
Mailing Address - Country:US
Mailing Address - Phone:201-989-2636
Mailing Address - Fax:
Practice Address - Street 1:251 SPRINGDALE AVE
Practice Address - Street 2:
Practice Address - City:EAST ORANGE
Practice Address - State:NJ
Practice Address - Zip Code:07017-4512
Practice Address - Country:US
Practice Address - Phone:201-989-2636
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-11
Last Update Date:2022-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist