Provider Demographics
NPI:1588670624
Name:FOWLER, KRISTIN KELLEN (MSPT)
Entity Type:Individual
Prefix:
First Name:KRISTIN
Middle Name:KELLEN
Last Name:FOWLER
Suffix:
Gender:F
Credentials:MSPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6400 DUTCHMANS PKWY
Mailing Address - Street 2:SUITE 20
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40205-3340
Mailing Address - Country:US
Mailing Address - Phone:502-897-0100
Mailing Address - Fax:502-897-7551
Practice Address - Street 1:6400 DUTCHMANS PKWY
Practice Address - Street 2:SUITE 20
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40205-3340
Practice Address - Country:US
Practice Address - Phone:502-897-0100
Practice Address - Fax:502-897-7551
Is Sole Proprietor?:No
Enumeration Date:2006-07-31
Last Update Date:2013-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY004154225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY186592Medicare ID - Type UnspecifiedGROUP PROVIDER NUMBER