Provider Demographics
NPI:1790721892
Name:FOWLER, JENNIFER D (MS, PT)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:D
Last Name:FOWLER
Suffix:
Gender:F
Credentials:MS, PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3317 N WIMBERLY DR FL 2
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72703-4056
Mailing Address - Country:US
Mailing Address - Phone:479-587-3185
Mailing Address - Fax:479-587-3185
Practice Address - Street 1:3317 N WIMBERLY DR FL 2
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:AR
Practice Address - Zip Code:72703-4056
Practice Address - Country:US
Practice Address - Phone:479-587-3185
Practice Address - Fax:479-587-3185
Is Sole Proprietor?:No
Enumeration Date:2006-06-20
Last Update Date:2023-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARPT2561225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist