Provider Demographics
NPI:1275293060
Name:LOWMAN, JESSE ALLEN
Entity Type:Individual
Prefix:
First Name:JESSE
Middle Name:ALLEN
Last Name:LOWMAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 872505
Mailing Address - Street 2:
Mailing Address - City:TEMPE
Mailing Address - State:AZ
Mailing Address - Zip Code:85287-2505
Mailing Address - Country:US
Mailing Address - Phone:480-220-6599
Mailing Address - Fax:
Practice Address - Street 1:500 E VETERANS WAY
Practice Address - Street 2:
Practice Address - City:TEMPE
Practice Address - State:AZ
Practice Address - Zip Code:85287-0001
Practice Address - Country:US
Practice Address - Phone:480-220-6599
Practice Address - Fax:480-727-5916
Is Sole Proprietor?:No
Enumeration Date:2021-12-21
Last Update Date:2021-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZATR-0008592255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer