Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251P0200X | Physical Therapist - Pediatrics | 1723 | ND |
NPI | 1023411386 |
---|---|
Provider Name | Ms. Theresa Marie Cowles |
First Address | Fargo, ND 58103-4868 |
Second Address | Fargo, ND 58102-3641 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 01/10/2014 |
Last Update Date | 01/10/2014 |