Provider Demographics
NPI:1316946528
Name:COWELL, CRAIG CARNEY (PT)
Entity type:Individual
Prefix:MR
First Name:CRAIG
Middle Name:CARNEY
Last Name:COWELL
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
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Mailing Address - Street 1:3960 COON RAPIDS BLVD NW
Mailing Address - Street 2:SUITE 205
Mailing Address - City:COON RAPIDS
Mailing Address - State:MN
Mailing Address - Zip Code:55433-2569
Mailing Address - Country:US
Mailing Address - Phone:763-576-3030
Mailing Address - Fax:763-576-8383
Practice Address - Street 1:2803 LINCOLN DR
Practice Address - Street 2:SUITE 302
Practice Address - City:ROSEVILLE
Practice Address - State:MN
Practice Address - Zip Code:55113-1332
Practice Address - Country:US
Practice Address - Phone:651-633-1593
Practice Address - Fax:651-633-1628
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-07-19
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MN1966225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN1966OtherMN STATE P.T. LICENSE