Provider Demographics
NPI:1720505910
Name:COWLES, BRENTON JOHN (PT, DPT)
Entity Type:Individual
Prefix:
First Name:BRENTON
Middle Name:JOHN
Last Name:COWLES
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6622 VISTA LOMA
Mailing Address - Street 2:
Mailing Address - City:YORBA LINDA
Mailing Address - State:CA
Mailing Address - Zip Code:92886-6454
Mailing Address - Country:US
Mailing Address - Phone:747-747-4725
Mailing Address - Fax:
Practice Address - Street 1:6622 VISTA LOMA
Practice Address - Street 2:
Practice Address - City:YORBA LINDA
Practice Address - State:CA
Practice Address - Zip Code:92886-6454
Practice Address - Country:US
Practice Address - Phone:747-747-4725
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-08-28
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA37499225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist