Provider Demographics
NPI:1962929984
Name:SOWLE, ERIC AARON (LAT, ATC, CSCS)
Entity type:Individual
Prefix:
First Name:ERIC
Middle Name:AARON
Last Name:SOWLE
Suffix:
Gender:M
Credentials:LAT, ATC, CSCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:614 HOEHNER PLACE
Mailing Address - Street 2:
Mailing Address - City:OKARCHE
Mailing Address - State:OK
Mailing Address - Zip Code:73762
Mailing Address - Country:US
Mailing Address - Phone:580-614-1794
Mailing Address - Fax:
Practice Address - Street 1:614 HOEHNER PL
Practice Address - Street 2:
Practice Address - City:OKARCHE
Practice Address - State:OK
Practice Address - Zip Code:73762-8816
Practice Address - Country:US
Practice Address - Phone:580-614-1794
Practice Address - Fax:580-614-1794
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-30
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
20000210622255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer