Basic Information
| Provider Information | |||||||||
| NPI: | 1972915684 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | COWLEY | ||||||||
| FirstName: | TRAVIS | ||||||||
| MiddleName: | JAMES | ||||||||
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| Credential: | PT, DPT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2113 AIRLINE DR | ||||||||
| Address2: | SUITE 100 | ||||||||
| City: | BOSSIER CITY | ||||||||
| State: | LA | ||||||||
| PostalCode: | 711113273 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3185193088 | ||||||||
| FaxNumber: | 3185193090 | ||||||||
| Practice Location | |||||||||
| Address1: | 2113 AIRLINE DR | ||||||||
| Address2: | SUITE 100 | ||||||||
| City: | BOSSIER CITY | ||||||||
| State: | LA | ||||||||
| PostalCode: | 711113273 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3185193088 | ||||||||
| FaxNumber: | 3185193090 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/29/2014 | ||||||||
| LastUpdateDate: | 05/29/2014 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 1243386 | TX | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.