Provider Demographics
NPI:1720573199
Name:FOWLER, CAROLYN WELLBORN (DPT)
Entity Type:Individual
Prefix:DR
First Name:CAROLYN
Middle Name:WELLBORN
Last Name:FOWLER
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:CAROLYN
Other - Middle Name:COX
Other - Last Name:WELLBORN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:4220 132ND ST SE STE 101
Mailing Address - Street 2:
Mailing Address - City:MILL CREEK
Mailing Address - State:WA
Mailing Address - Zip Code:98012-8999
Mailing Address - Country:US
Mailing Address - Phone:425-316-8046
Mailing Address - Fax:425-659-7449
Practice Address - Street 1:15446 BEL RED RD STE B20
Practice Address - Street 2:
Practice Address - City:REDMOND
Practice Address - State:WA
Practice Address - Zip Code:98052-5526
Practice Address - Country:US
Practice Address - Phone:425-869-2777
Practice Address - Fax:425-869-0167
Is Sole Proprietor?:No
Enumeration Date:2018-06-27
Last Update Date:2021-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA097502251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic