Healthcare Provider Details

I. General information

NPI: 1275033771
Provider Name (Legal Business Name): ARMENTA FOWLER PTA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/20/2018
Last Update Date: 03/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

920 COLLOREDO BLVD
SHELBYVILLE TN
37160-2779
US

IV. Provider business mailing address

433 ADELINE DR
SMYRNA TN
37167-5230
US

V. Phone/Fax

Practice location:
  • Phone: 931-684-3066
  • Fax:
Mailing address:
  • Phone: 615-459-2460
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number6048
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: