Provider Demographics
NPI:1629217005
Name:SOWVLEN, KEVIN M (PTA)
Entity Type:Individual
Prefix:MR
First Name:KEVIN
Middle Name:M
Last Name:SOWVLEN
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16148 CAYENNE CREEK RD
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92127-3709
Mailing Address - Country:US
Mailing Address - Phone:858-312-1971
Mailing Address - Fax:
Practice Address - Street 1:16148 CAYENNE CREEK RD
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92127-3709
Practice Address - Country:US
Practice Address - Phone:858-312-1971
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-02-09
Last Update Date:2009-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAT-4714225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant