1316946528 NPI number — MR. CRAIG CARNEY COWELL P.T.

Table of content: MR. CRAIG CARNEY COWELL P.T. (NPI 1316946528)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1316946528 NPI number — MR. CRAIG CARNEY COWELL P.T.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
COWELL
Provider First Name:
CRAIG
Provider Middle Name:
CARNEY
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
P.T.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1316946528
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3960 COON RAPIDS BLVD NW
Provider Second Line Business Mailing Address:
SUITE 205
Provider Business Mailing Address City Name:
COON RAPIDS
Provider Business Mailing Address State Name:
MN
Provider Business Mailing Address Postal Code:
55433-2569
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
763-576-3030
Provider Business Mailing Address Fax Number:
763-576-8383

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2803 LINCOLN DR
Provider Second Line Business Practice Location Address:
SUITE 302
Provider Business Practice Location Address City Name:
ROSEVILLE
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
55113-1332
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
651-633-1593
Provider Business Practice Location Address Fax Number:
651-633-1628
Provider Enumeration Date:
07/19/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 225100000X , with the licence number:  1966 , registered in the state of MN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1966 . This is a "MN STATE P.T. LICENSE" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".




Copyright © 2007-2024 www.npivalidator.com