Individual
TANNER FOWLER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
1306 THE ALAMEDA APT 221, SAN JOSE, CA 95126-5014
(308) 991-5227
Mailing address
1306 THE ALAMEDA APT 221, SAN JOSE, CA 95126-5014
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
—
—
Other
Enumeration date
08/06/2019
Last updated
08/06/2019
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