Healthcare Provider Details

I. General information

NPI: 1598992414
Provider Name (Legal Business Name): FOWLER PHYSICAL THERAPY, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/18/2009
Last Update Date: 05/03/2021
Certification Date: 05/03/2021
Deactivation Date: 09/13/2019
Reactivation Date: 10/23/2019

III. Provider practice location address

1508 W INNES ST
SALISBURY NC
28144-2504
US

IV. Provider business mailing address

142 CHURCHILL DR
SALISBURY NC
28144-8306
US

V. Phone/Fax

Practice location:
  • Phone: 704-630-9656
  • Fax: 704-630-9658
Mailing address:
  • Phone: 704-630-9656
  • Fax: 704-630-9658

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number9707
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code2251E1200X
TaxonomyErgonomics Physical Therapist
License Number9707
License Number StateNC
# 3
Primary TaxonomyN
Taxonomy Code2251S0007X
TaxonomySports Physical Therapist
License Number9707
License Number StateNC
# 4
Primary TaxonomyN
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License Number9707
License Number StateNC

VIII. Authorized Official

Name: DR. DELAINE FOWLER
Title or Position: CEO
Credential: PT, DPT, CSCS
Phone: 336-266-4392