Provider Demographics
NPI:1770831182
Name:FOWLER, JANET SUZANNE (PT)
Entity type:Individual
Prefix:MRS
First Name:JANET
Middle Name:SUZANNE
Last Name:FOWLER
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1104 SPRING CREEK LN
Mailing Address - Street 2:
Mailing Address - City:LEWISVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:75067-7448
Mailing Address - Country:US
Mailing Address - Phone:972-315-0103
Mailing Address - Fax:
Practice Address - Street 1:401 N VALLEY PKWY STE 380
Practice Address - Street 2:
Practice Address - City:LEWISVILLE
Practice Address - State:TX
Practice Address - Zip Code:75067-3472
Practice Address - Country:US
Practice Address - Phone:972-353-5437
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-16
Last Update Date:2012-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1056570225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist