MEDICARE: MICHELLE B FOWLER PT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	1180840	TX

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	AB15898	OTHER	TX	MEDICARE ID - TYPE UNSPECIFIED

General Provider Information

NPI Number	:	1407810492
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHELLE B FOWLER PT

Provider Business Mailing Address
First Line	:	6692 PEARL RIDGE DR
Second Line	:
City	:	EL PASO
State	:	TX
Zip	:	79912-7209
Country	:	US
Telephone Number	:	415-208-1127
Fax Number	:

Provider Business Practice Location Address
First Line	:	6358 EDGEMERE BLVD
Second Line	:
City	:	EL PASO
State	:	TX
Zip	:	79925-3517
Country	:	US
Telephone Number	:	915-562-8525
Fax Number	:	915-566-3889

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/14/2006
Last Update Date	:	03/19/2009

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Directions to “ MICHELLE B FOWLER PT” Practice Location

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