Provider Demographics
NPI:1609225663
Name:COWELL, KEVIN MICHAEL
Entity Type:Individual
Prefix:
First Name:KEVIN
Middle Name:MICHAEL
Last Name:COWELL
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 1:295 E SPEER BLVD APT 201
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80203-3555
Mailing Address - Country:US
Mailing Address - Phone:949-378-6023
Mailing Address - Fax:
Practice Address - Street 1:56171 COLFAX AVE
Practice Address - Street 2:
Practice Address - City:STRASBURG
Practice Address - State:CO
Practice Address - Zip Code:80136
Practice Address - Country:US
Practice Address - Phone:303-622-6680
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-09
Last Update Date:2016-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO140222251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic