Provider Demographics
NPI:1275307167
Name:LOWELL, AVA ELIZABETH (PT, DPT)
Entity Type:Individual
Prefix:
First Name:AVA
Middle Name:ELIZABETH
Last Name:LOWELL
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2807 W AGATE ST
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83705-1719
Mailing Address - Country:US
Mailing Address - Phone:303-709-4833
Mailing Address - Fax:
Practice Address - Street 1:672 E WYTHE CREEK CT
Practice Address - Street 2:
Practice Address - City:KUNA
Practice Address - State:ID
Practice Address - Zip Code:83634-5216
Practice Address - Country:US
Practice Address - Phone:208-992-9828
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-11-10
Last Update Date:2023-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID8885225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist