Provider Demographics
NPI:1093912313
Name:LOWE, JOHN RUSSELL (MPT, MAT, LAT, ATC)
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:RUSSELL
Last Name:LOWE
Suffix:
Gender:M
Credentials:MPT, MAT, LAT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4206 49TH ST
Mailing Address - Street 2:
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79413-3722
Mailing Address - Country:US
Mailing Address - Phone:806-241-5328
Mailing Address - Fax:
Practice Address - Street 1:4642 N LOOP 289 STE 205
Practice Address - Street 2:
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79416-2424
Practice Address - Country:US
Practice Address - Phone:806-775-9275
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1151247225100000X
TXAT20262255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Not Answered2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer