Provider Demographics
NPI:1417082553
Name:DOWELL, THERESA (PT)
Entity Type:Individual
Prefix:
First Name:THERESA
Middle Name:
Last Name:DOWELL
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1515 E CEDAR AVE
Mailing Address - Street 2:STE C-1
Mailing Address - City:FLAGSTAFF
Mailing Address - State:AZ
Mailing Address - Zip Code:86004-1637
Mailing Address - Country:US
Mailing Address - Phone:928-774-1811
Mailing Address - Fax:928-774-2006
Practice Address - Street 1:1501 S YALE ST
Practice Address - Street 2:STE# 252
Practice Address - City:FLAGSTAFF
Practice Address - State:AZ
Practice Address - Zip Code:86001-7304
Practice Address - Country:US
Practice Address - Phone:928-774-1811
Practice Address - Fax:928-774-2006
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-22
Last Update Date:2019-10-27
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AZ3278225100000X
AZ4741363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist