MEDICARE: MR. JASON LEE FOWLER P.T.

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	004150	KY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	6464207	OTHER		CIGNA PROVIDER ID NUMBER
2	6830783	OTHER		UNITED HEALTHCARE PROVIDER ID NUMBER
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	CS2003600562	OTHER		CARESOURCE PROVIDER ID NUMBER
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
6	000001332483	OTHER		ANTHEM PROVIDER ID NUMBER
7	2143551	OTHER	KY	WELLCARE OF KY PROVIDER ID NUMBER
8	PDZ000000455121	OTHER	KY	AETNA BETTER HEALTH OF KY PROVIDER ID NUMBER

General Provider Information

NPI Number	:	1962677708
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. JASON LEE FOWLER P.T.

Provider Business Mailing Address
First Line	:	1200 CORPORATE DR STE 400
Second Line	:
City	:	HOOVER
State	:	AL
Zip	:	35242-5424
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3099 BRECKENRIDGE LN STE 107
Second Line	:
City	:	LOUISVILLE
State	:	KY
Zip	:	40220-2120
Country	:	US
Telephone Number	:	502-963-5229
Fax Number	:	502-963-5365

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

Provider Enumeration Date	:	04/23/2008
Last Update Date	:	07/12/2022

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Directions to “ MR. JASON LEE FOWLER P.T.” Practice Location

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