Healthcare Provider Details

I. General information

NPI: 1326689738
Provider Name (Legal Business Name): JOHN KYLE GOWENS PTA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/07/2019
Last Update Date: 10/07/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

153 NARROWS PKWY
BIRMINGHAM AL
35242-8600
US

IV. Provider business mailing address

6397 LEE HWY STE 300
CHATTANOOGA TN
37421-4915
US

V. Phone/Fax

Practice location:
  • Phone: 205-981-4534
  • Fax: 205-981-4535
Mailing address:
  • Phone: 423-238-7217
  • Fax: 423-238-3473

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License NumberPTA9455
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: