| NPI | 1184052573 |
|---|---|
| Former Name | JESSICA FOWLER |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NC 15532) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: VA 2305208099) |
| Enumeration Date | 2013-10-22 |
| Last Update Date | 2016-02-24 |