Provider Demographics
NPI:1528371044
Name:COWIE, JONATHAN D
Entity Type:Individual
Prefix:
First Name:JONATHAN
Middle Name:D
Last Name:COWIE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:73 NEWTON RD
Mailing Address - Street 2:STE 101
Mailing Address - City:PLAISTOW
Mailing Address - State:NH
Mailing Address - Zip Code:03865-2424
Mailing Address - Country:US
Mailing Address - Phone:978-388-7272
Mailing Address - Fax:978-388-7373
Practice Address - Street 1:1190 LISBON ST
Practice Address - Street 2:UNIT 101
Practice Address - City:LEWISTON
Practice Address - State:ME
Practice Address - Zip Code:04240-5063
Practice Address - Country:US
Practice Address - Phone:207-376-3000
Practice Address - Fax:207-376-3003
Is Sole Proprietor?:No
Enumeration Date:2010-07-26
Last Update Date:2015-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPT3688225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MEE400101205Medicare PIN