Provider Demographics
NPI:1619275450
Name:FOWLER, SHONA (PT, DPT)
Entity Type:Individual
Prefix:
First Name:SHONA
Middle Name:
Last Name:FOWLER
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:38W681 W MARY LN
Mailing Address - Street 2:
Mailing Address - City:ST CHARLES
Mailing Address - State:IL
Mailing Address - Zip Code:60175-5504
Mailing Address - Country:US
Mailing Address - Phone:630-802-0278
Mailing Address - Fax:
Practice Address - Street 1:38W681 W MARY LN
Practice Address - Street 2:
Practice Address - City:ST CHARLES
Practice Address - State:IL
Practice Address - Zip Code:60175-5504
Practice Address - Country:US
Practice Address - Phone:630-802-2078
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-03
Last Update Date:2012-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070.005512225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist