Provider Demographics
NPI:1689709313
Name:SOWER, CHARLENE A (BS,PT)
Entity Type:Individual
Prefix:
First Name:CHARLENE
Middle Name:A
Last Name:SOWER
Suffix:
Gender:F
Credentials:BS,PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1600 3RD AVE
Mailing Address - Street 2:
Mailing Address - City:LONGVIEW
Mailing Address - State:WA
Mailing Address - Zip Code:98632-3231
Mailing Address - Country:US
Mailing Address - Phone:360-425-9810
Mailing Address - Fax:360-425-1053
Practice Address - Street 1:1600 3RD AVE
Practice Address - Street 2:
Practice Address - City:LONGVIEW
Practice Address - State:WA
Practice Address - Zip Code:98632-3231
Practice Address - Country:US
Practice Address - Phone:360-425-9810
Practice Address - Fax:360-425-1053
Is Sole Proprietor?:No
Enumeration Date:2007-02-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT0002843174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist