Provider Demographics
NPI:1063071751
Name:SOWELLS, KEDRON PATRICK (PT, DPT)
Entity type:Individual
Prefix:DR
First Name:KEDRON
Middle Name:PATRICK
Last Name:SOWELLS
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1531 INSPIRATION DR APT 3070
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75207-3773
Mailing Address - Country:US
Mailing Address - Phone:214-713-7268
Mailing Address - Fax:
Practice Address - Street 1:3107 W CAMP WISDOM RD STE 131
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75237-2600
Practice Address - Country:US
Practice Address - Phone:214-339-4533
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-06
Last Update Date:2019-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX3124158225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist