Provider Demographics
NPI:1356502140
Name:COWAN, SCOTT S (PTA)
Entity Type:Individual
Prefix:
First Name:SCOTT
Middle Name:S
Last Name:COWAN
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 1:2592 E GRAND AVE STE 209
Mailing Address - Street 2:
Mailing Address - City:LINDENHURST
Mailing Address - State:IL
Mailing Address - Zip Code:60046-5915
Mailing Address - Country:US
Mailing Address - Phone:847-265-1460
Mailing Address - Fax:
Practice Address - Street 1:750 ESSINGTON RD
Practice Address - Street 2:
Practice Address - City:JOLIET
Practice Address - State:IL
Practice Address - Zip Code:60435-4912
Practice Address - Country:US
Practice Address - Phone:815-729-2160
Practice Address - Fax:815-373-0099
Is Sole Proprietor?:No
Enumeration Date:2008-06-24
Last Update Date:2019-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL160004192225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant