1467634469 NPI number — FOWLER ENTERPRISES INC.

Table of content: (NPI 1467634469)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1467634469 NPI number — FOWLER ENTERPRISES INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
FOWLER ENTERPRISES INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
EAST MOUNTAIN PHYSICAL THERAPY
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1467634469
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/09/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1730
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MORIARTY
Provider Business Mailing Address State Name:
NM
Provider Business Mailing Address Postal Code:
87035-1730
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
505-832-4011
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
12127 B3 N. HWY 14
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CEDAR CREST
Provider Business Practice Location Address State Name:
NM
Provider Business Practice Location Address Postal Code:
87008
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
505-286-3678
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
11/30/2007

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
FOWLER
Authorized Official First Name:
CHERYL
Authorized Official Middle Name:
W
Authorized Official Title or Position:
OWNER/ AUTHORIZED REPRESENTATIVE
Authorized Official Telephone Number:
505-220-6949

Provider Taxonomy Codes

  • Taxonomy code: 225100000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 08028079 , issued by the state of ( NM ) . This identifiers is of the category "MEDICAID".