Provider Demographics
NPI:1780012781
Name:COWAN, JACQUELINE (DPT)
Entity Type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:
Last Name:COWAN
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7087 ESTRELLA DE MAR RD # C9
Mailing Address - Street 2:
Mailing Address - City:CARLSBAD
Mailing Address - State:CA
Mailing Address - Zip Code:92009-6148
Mailing Address - Country:US
Mailing Address - Phone:858-888-3814
Mailing Address - Fax:
Practice Address - Street 1:312 S CEDROS AVE STE 206
Practice Address - Street 2:
Practice Address - City:SOLANA BEACH
Practice Address - State:CA
Practice Address - Zip Code:92075-1942
Practice Address - Country:US
Practice Address - Phone:858-888-3814
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-10-29
Last Update Date:2013-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA371152251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic