Provider Demographics
NPI:1114281516
Name:DOWL, DONALD RAY SR (LMT)
Entity Type:Individual
Prefix:MR
First Name:DONALD
Middle Name:RAY
Last Name:DOWL
Suffix:SR
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1119 TOREADOR DR
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63141-6051
Mailing Address - Country:US
Mailing Address - Phone:314-392-1415
Mailing Address - Fax:
Practice Address - Street 1:1119 TOREADOR DR
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63141-6051
Practice Address - Country:US
Practice Address - Phone:314-392-1415
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-06-29
Last Update Date:2012-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2012017541225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist