Provider Demographics
NPI:1770265258
Name:FOWLER, JOSHUA ANDREW
Entity type:Individual
Prefix:
First Name:JOSHUA
Middle Name:ANDREW
Last Name:FOWLER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10116 DE ANZA CIR
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79925-7324
Mailing Address - Country:US
Mailing Address - Phone:915-238-5871
Mailing Address - Fax:
Practice Address - Street 1:5255 WOODROW BEAN
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79924-3832
Practice Address - Country:US
Practice Address - Phone:915-206-4428
Practice Address - Fax:915-257-3511
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-03
Last Update Date:2023-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2176368225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant