Provider Demographics
NPI:1831763325
Name:COWEN, SPENCER DAVID (PT, DPT)
Entity type:Individual
Prefix:DR
First Name:SPENCER
Middle Name:DAVID
Last Name:COWEN
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 1:200 GRACE LN
Mailing Address - Street 2:
Mailing Address - City:NICHOLASVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40356-9098
Mailing Address - Country:US
Mailing Address - Phone:859-967-7018
Mailing Address - Fax:
Practice Address - Street 1:1650 BRYAN STATION RD
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40505-2138
Practice Address - Country:US
Practice Address - Phone:859-293-6133
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-18
Last Update Date:2022-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY008248225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist