Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225200000X | Physical Therapy Assistant | 2120176 | TX |
NPI | 1003393182 |
---|---|
Provider Name | Donald Fowler |
First Address | Hurst, TX 76053 |
Second Address | Temple, TX 76504-6823 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 23/07/2018 |
Last Update Date | 23/07/2018 |