Provider Demographics
NPI:1699715193
Name:MOWRY, SHERESE L (PT)
Entity type:Individual
Prefix:MRS
First Name:SHERESE
Middle Name:L
Last Name:MOWRY
Suffix:
Gender:F
Credentials:PT
Other - Prefix:MRS
Other - First Name:SHERESE
Other - Middle Name:L
Other - Last Name:MOWRY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PHYSICAL THERAPIST
Mailing Address - Street 1:6704 KESTREL CIR
Mailing Address - Street 2:
Mailing Address - City:FT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33912-1365
Mailing Address - Country:US
Mailing Address - Phone:239-561-6767
Mailing Address - Fax:
Practice Address - Street 1:6704 KESTREL CIR
Practice Address - Street 2:
Practice Address - City:FT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33912-1365
Practice Address - Country:US
Practice Address - Phone:239-561-6767
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL13380225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist