Provider Demographics
NPI:1053398016
Name:COWGILL, SALLIE J (PT)
Entity type:Individual
Prefix:
First Name:SALLIE
Middle Name:J
Last Name:COWGILL
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:SALLIE
Other - Middle Name:J
Other - Last Name:CAVANAUGH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:790 REMINGTON BLVD
Mailing Address - Street 2:
Mailing Address - City:BOLINGBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60440-4909
Mailing Address - Country:US
Mailing Address - Phone:630-296-2223
Mailing Address - Fax:
Practice Address - Street 1:1188 106TH AVE NE
Practice Address - Street 2:SUITE 100
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98004-8612
Practice Address - Country:US
Practice Address - Phone:425-455-2630
Practice Address - Fax:425-451-4390
Is Sole Proprietor?:No
Enumeration Date:2005-12-29
Last Update Date:2015-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT00000848225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8335648Medicaid
WAGAB16645Medicare PIN
WAP10332Medicare UPIN