Provider Demographics
NPI:1720343460
Name:COWERN, RHONDA GRACE (DPT)
Entity Type:Individual
Prefix:MRS
First Name:RHONDA
Middle Name:GRACE
Last Name:COWERN
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:RHONDA
Other - Middle Name:GRACE
Other - Last Name:MAYO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:131 E 100 S
Mailing Address - Street 2:
Mailing Address - City:MOAB
Mailing Address - State:UT
Mailing Address - Zip Code:84532-2641
Mailing Address - Country:US
Mailing Address - Phone:435-210-1985
Mailing Address - Fax:435-355-0410
Practice Address - Street 1:131 E 100 S
Practice Address - Street 2:
Practice Address - City:MOAB
Practice Address - State:UT
Practice Address - Zip Code:84532-2641
Practice Address - Country:US
Practice Address - Phone:435-210-1985
Practice Address - Fax:435-355-0410
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-09
Last Update Date:2021-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT8212548-2401225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist