Healthcare Provider Details

I. General information

NPI: 1073835062
Provider Name (Legal Business Name): JENNIFER ERLENE FOWLER PT,DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/18/2010
Last Update Date: 03/11/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

620 N ALLEGHANEY AVE
ODESSA TX
79761-4408
US

IV. Provider business mailing address

2415 IDLEWILDE DR APT 4
MIDLAND TX
79707-6134
US

V. Phone/Fax

Practice location:
  • Phone: 432-332-8244
  • Fax: 432-580-7428
Mailing address:
  • Phone: 432-940-1390
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number1194128
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: