Provider Demographics
NPI:1083203178
Name:FOWLER, MICHAEL A (DPT)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:A
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 1:33487 HARPER AVE
Mailing Address - Street 2:
Mailing Address - City:CLINTON TOWNSHIP
Mailing Address - State:MI
Mailing Address - Zip Code:48035-4253
Mailing Address - Country:US
Mailing Address - Phone:586-388-0016
Mailing Address - Fax:
Practice Address - Street 1:33487 HARPER AVE
Practice Address - Street 2:
Practice Address - City:CLINTON TOWNSHIP
Practice Address - State:MI
Practice Address - Zip Code:48035-4253
Practice Address - Country:US
Practice Address - Phone:586-388-0016
Practice Address - Fax:586-388-0015
Is Sole Proprietor?:No
Enumeration Date:2021-01-13
Last Update Date:2023-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501019905225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist