Healthcare Provider Details

I. General information

NPI: 1255390845
Provider Name (Legal Business Name): MICHAEL ARLYN BLOWERS PT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/22/2006
Last Update Date: 12/22/2022
Certification Date: 12/22/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1100 WILFORD HALL LOOP BLDG 4554
JBSA LACKLAND TX
78236-5638
US

IV. Provider business mailing address

WHASC 1100 WILFORD HALL LOOP, BLDG 4554
JBSA LACKLAND TX
78234
US

V. Phone/Fax

Practice location:
  • Phone: 210-808-1073
  • Fax:
Mailing address:
  • Phone: 210-808-1073
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171000000X
TaxonomyMilitary Health Care Provider
License Number018349-1
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: