MEDICARE: MICHAEL FOWLER DPT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	PT-1178	WY

General Provider Information

NPI Number	:	1487083861
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHAEL FOWLER DPT

Provider Business Mailing Address
First Line	:	1941 E A ST
Second Line	:
City	:	CASPER
State	:	WY
Zip	:	82601-2224
Country	:	US
Telephone Number	:	307-337-1624
Fax Number	:	307-337-1626

Provider Business Practice Location Address
First Line	:	1941 E A ST
Second Line	:
City	:	CASPER
State	:	WY
Zip	:	82601-2224
Country	:	US
Telephone Number	:	307-337-1624
Fax Number	:	307-337-1626

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/05/2013
Last Update Date	:	12/11/2020

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