Provider Demographics
NPI:1154726446
Name:LOWE, BRIAN DAVID (MS, ATC)
Entity type:Individual
Prefix:
First Name:BRIAN
Middle Name:DAVID
Last Name:LOWE
Suffix:
Gender:M
Credentials:MS, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:236 HALEY BROOKE DR
Mailing Address - Street 2:
Mailing Address - City:CONWAY
Mailing Address - State:SC
Mailing Address - Zip Code:29526-6399
Mailing Address - Country:US
Mailing Address - Phone:360-213-3620
Mailing Address - Fax:
Practice Address - Street 1:2439 WILLWOOD DR
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:SC
Practice Address - Zip Code:29501-3904
Practice Address - Country:US
Practice Address - Phone:360-213-3620
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-10-29
Last Update Date:2014-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer