Individual
IRA FOWLER JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PT
Contact information
Practice address
711 AVIGNON DR, RIDGELAND, MS 39157-5120
(601) 605-6777
(601) 607-1389
Mailing address
711 AVIGNON DR, RIDGELAND, MS 39157-5120
(601) 605-6777
(601) 607-1389
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
PT0229
MS
Other
Enumeration date
10/21/2010
Last updated
10/21/2010
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