Provider Demographics
NPI:1487083861
Name:FOWLER, MICHAEL (DPT)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:
Last Name:FOWLER
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1941 E A ST
Mailing Address - Street 2:
Mailing Address - City:CASPER
Mailing Address - State:WY
Mailing Address - Zip Code:82601-2224
Mailing Address - Country:US
Mailing Address - Phone:307-337-1624
Mailing Address - Fax:307-337-1626
Practice Address - Street 1:1941 E A ST
Practice Address - Street 2:
Practice Address - City:CASPER
Practice Address - State:WY
Practice Address - Zip Code:82601-2224
Practice Address - Country:US
Practice Address - Phone:307-337-1624
Practice Address - Fax:307-337-1626
Is Sole Proprietor?:No
Enumeration Date:2013-11-05
Last Update Date:2020-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WYPT-1178225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist