Provider Demographics
NPI:1588647531
Name:COWBOYS AND ANGELS THERAPY INC.
Entity Type:Organization
Organization Name:COWBOYS AND ANGELS THERAPY INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:VICTORIA
Authorized Official - Middle Name:
Authorized Official - Last Name:FROST
Authorized Official - Suffix:
Authorized Official - Credentials:OT
Authorized Official - Phone:330-239-4491
Mailing Address - Street 1:5047 DUNSHA RD
Mailing Address - Street 2:
Mailing Address - City:MEDINA
Mailing Address - State:OH
Mailing Address - Zip Code:44256-8483
Mailing Address - Country:US
Mailing Address - Phone:330-239-4491
Mailing Address - Fax:330-239-4490
Practice Address - Street 1:5047 DUNSHA RD
Practice Address - Street 2:
Practice Address - City:MEDINA
Practice Address - State:OH
Practice Address - Zip Code:44256-8483
Practice Address - Country:US
Practice Address - Phone:330-239-4491
Practice Address - Fax:330-239-4490
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
Not Answered225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHCO9352191Medicare ID - Type Unspecified