Provider Demographics
NPI:1396301560
Name:COWAN, BETHANY LABOSSIER
Entity type:Individual
Prefix:
First Name:BETHANY
Middle Name:LABOSSIER
Last Name:COWAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2117 MCCOMAS WAY STE 105
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23456-3908
Mailing Address - Country:US
Mailing Address - Phone:757-427-5505
Mailing Address - Fax:757-427-5503
Practice Address - Street 1:2117 MCCOMAS WAY STE 105
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23456-3908
Practice Address - Country:US
Practice Address - Phone:757-427-5505
Practice Address - Fax:757-427-5503
Is Sole Proprietor?:No
Enumeration Date:2019-05-14
Last Update Date:2022-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305213012225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist