Provider Demographics
NPI:1508193566
Name:DOVE, WAYNETTE COWSER (PT)
Entity Type:Individual
Prefix:
First Name:WAYNETTE
Middle Name:COWSER
Last Name:DOVE
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7039 MARY TODD
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78240-4045
Mailing Address - Country:US
Mailing Address - Phone:210-462-7683
Mailing Address - Fax:
Practice Address - Street 1:8645 FREDERICKSBURG RD
Practice Address - Street 2:SUITE 540
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78240-1201
Practice Address - Country:US
Practice Address - Phone:210-558-9001
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-12
Last Update Date:2012-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1054989225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1233478OtherCAQH