Provider Demographics
NPI:1962720995
Name:COWAN, KURTIS (RPT)
Entity type:Individual
Prefix:DR
First Name:KURTIS
Middle Name:
Last Name:COWAN
Suffix:
Gender:M
Credentials:RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8438 MAURER RD APT 1311
Mailing Address - Street 2:
Mailing Address - City:LENEXA
Mailing Address - State:KS
Mailing Address - Zip Code:66219-2781
Mailing Address - Country:US
Mailing Address - Phone:269-277-3271
Mailing Address - Fax:
Practice Address - Street 1:15055 W 87TH STREET PKWY
Practice Address - Street 2:
Practice Address - City:LENEXA
Practice Address - State:KS
Practice Address - Zip Code:66215-5372
Practice Address - Country:US
Practice Address - Phone:913-307-0665
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-14
Last Update Date:2010-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS11-037722251G0304X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251G0304XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGeriatrics