Provider Demographics
NPI:1568912392
Name:MOWREY, DARLENE (DPT)
Entity Type:Individual
Prefix:
First Name:DARLENE
Middle Name:
Last Name:MOWREY
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:323 NELSON ST
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:NE
Mailing Address - Zip Code:68873-2238
Mailing Address - Country:US
Mailing Address - Phone:317-750-6676
Mailing Address - Fax:
Practice Address - Street 1:819 N DIERS AVE STE 7
Practice Address - Street 2:
Practice Address - City:GRAND ISLAND
Practice Address - State:NE
Practice Address - Zip Code:68803-4957
Practice Address - Country:US
Practice Address - Phone:308-270-3828
Practice Address - Fax:308-624-4071
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-05
Last Update Date:2024-01-26
Deactivation Date:2017-11-07
Deactivation Code:
Reactivation Date:2020-09-11
Provider Licenses
StateLicense IDTaxonomies
NE3625225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE47065477701Medicaid