MEDICARE: MRS. CHERYL W FOWLER P.T.

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	1037	NM

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1518030287
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. CHERYL W FOWLER P.T.

Provider Business Mailing Address
First Line	:	12127 HIGHWAY 14 N
Second Line	:	SUITE B3
City	:	CEDAR CREST
State	:	NM
Zip	:	87008-9461
Country	:	US
Telephone Number	:	505-286-3678
Fax Number	:	505-286-3688

Provider Business Practice Location Address
First Line	:	12127 STATE HIGHWAY 14 N STE B3
Second Line	:
City	:	CEDAR CREST
State	:	NM
Zip	:	87008-9462
Country	:	US
Telephone Number	:	505-286-3678
Fax Number	:	505-286-3688

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

Provider Enumeration Date	:	11/17/2006
Last Update Date	:	01/23/2012

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