Provider Demographics
NPI:1598836199
Name:FOWLER, KIRBY W (PT)
Entity Type:Individual
Prefix:
First Name:KIRBY
Middle Name:W
Last Name:FOWLER
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:819 WATER ST
Mailing Address - Street 2:SUITE 300
Mailing Address - City:KERRVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78028-5333
Mailing Address - Country:US
Mailing Address - Phone:830-792-3300
Mailing Address - Fax:830-792-5771
Practice Address - Street 1:714 E MAIN ST
Practice Address - Street 2:
Practice Address - City:UVALDE
Practice Address - State:TX
Practice Address - Zip Code:78801-5719
Practice Address - Country:US
Practice Address - Phone:830-278-6261
Practice Address - Fax:830-278-4966
Is Sole Proprietor?:No
Enumeration Date:2006-11-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1034767225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist