Provider Demographics
NPI:1013498617
Name:FOWLER, NELEIGH (DPT)
Entity Type:Individual
Prefix:MRS
First Name:NELEIGH
Middle Name:
Last Name:FOWLER
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:NELEIGH
Other - Middle Name:
Other - Last Name:FRANDSEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:1306 THE ALAMEDA APT 221
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95126-5014
Mailing Address - Country:US
Mailing Address - Phone:402-525-9153
Mailing Address - Fax:
Practice Address - Street 1:20823 STEVENS CREEK BLVD STE 200
Practice Address - Street 2:
Practice Address - City:CUPERTINO
Practice Address - State:CA
Practice Address - Zip Code:95014-2112
Practice Address - Country:US
Practice Address - Phone:408-252-6076
Practice Address - Fax:408-252-1159
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-22
Last Update Date:2020-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT295223225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist