Provider Demographics
NPI:1194085233
Name:COWAN, DIANE J (PTA, CPI)
Entity type:Individual
Prefix:
First Name:DIANE
Middle Name:J
Last Name:COWAN
Suffix:
Gender:F
Credentials:PTA, CPI
Other - Prefix:
Other - First Name:DIANE
Other - Middle Name:J
Other - Last Name:DAVIDSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PTA
Mailing Address - Street 1:8705 STONEWALL RD
Mailing Address - Street 2:
Mailing Address - City:MANASSAS
Mailing Address - State:VA
Mailing Address - Zip Code:20110-4534
Mailing Address - Country:US
Mailing Address - Phone:703-368-7343
Mailing Address - Fax:703-368-0719
Practice Address - Street 1:8705 STONEWALL RD
Practice Address - Street 2:
Practice Address - City:MANASSAS
Practice Address - State:VA
Practice Address - Zip Code:20110-4534
Practice Address - Country:US
Practice Address - Phone:703-368-7343
Practice Address - Fax:703-368-0719
Is Sole Proprietor?:No
Enumeration Date:2012-05-23
Last Update Date:2012-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA23060000397225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant