Provider Demographics
NPI:1093214850
Name:COWLEY, ROBERT (PT, DPT, OCS)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:
Last Name:COWLEY
Suffix:
Gender:M
Credentials:PT, DPT, OCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12544 DILLINGHAM SQ
Mailing Address - Street 2:
Mailing Address - City:WOODBRIDGE
Mailing Address - State:VA
Mailing Address - Zip Code:22192-5259
Mailing Address - Country:US
Mailing Address - Phone:703-730-6969
Mailing Address - Fax:703-730-1169
Practice Address - Street 1:12731 MARBLESTONE DR STE 202
Practice Address - Street 2:
Practice Address - City:WOODBRIDGE
Practice Address - State:VA
Practice Address - Zip Code:22192-8334
Practice Address - Country:US
Practice Address - Phone:571-659-2612
Practice Address - Fax:571-659-2619
Is Sole Proprietor?:No
Enumeration Date:2018-02-07
Last Update Date:2022-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305211753225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist