Provider Demographics
NPI:1598969750
Name:FOWLER, JEREMIE DON (CRT)
Entity Type:Individual
Prefix:
First Name:JEREMIE
Middle Name:DON
Last Name:FOWLER
Suffix:
Gender:M
Credentials:CRT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:387 DIMAGGIO DR
Mailing Address - Street 2:
Mailing Address - City:TOOELE
Mailing Address - State:UT
Mailing Address - Zip Code:84074-9297
Mailing Address - Country:US
Mailing Address - Phone:435-882-4476
Mailing Address - Fax:
Practice Address - Street 1:4885 S 900 E
Practice Address - Street 2:SUITE 107
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84117-5746
Practice Address - Country:US
Practice Address - Phone:801-266-0399
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT335516-57012278P1005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2278P1005XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRespiratory Therapist, CertifiedPulmonary Rehabilitation