Healthcare Provider Details

I. General information

NPI: 1588842579
Provider Name (Legal Business Name): ALEXANDER STEPHEN FOWLER MSPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/01/2008
Last Update Date: 10/23/2024
Certification Date: 10/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

817 PIONEER AVE
CASHMERE WA
98815-1235
US

IV. Provider business mailing address

1161 UPPER PEAVINE CANYON RD
WENATCHEE WA
98801-6055
US

V. Phone/Fax

Practice location:
  • Phone: 509-782-1251
  • Fax:
Mailing address:
  • Phone: 509-679-8026
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT00007855
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: