Provider Demographics
NPI:1235247875
Name:COWLEY, JANE
Entity Type:Individual
Prefix:
First Name:JANE
Middle Name:
Last Name:COWLEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1405 QUANT AVE S
Mailing Address - Street 2:
Mailing Address - City:LAKELAND
Mailing Address - State:MN
Mailing Address - Zip Code:55043-9438
Mailing Address - Country:US
Mailing Address - Phone:651-436-5203
Mailing Address - Fax:
Practice Address - Street 1:1812 N SAINT PAUL RD
Practice Address - Street 2:
Practice Address - City:MAPLEWOOD
Practice Address - State:MN
Practice Address - Zip Code:55109-4706
Practice Address - Country:US
Practice Address - Phone:651-779-8550
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FM4807OtherLICENSE #