Individual
TAILER PAIGE FOWLER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
3111 CHANNING WAY, IDAHO FALLS, ID 83404-7534
(208) 529-0067
Mailing address
225 E 14TH ST, IDAHO FALLS, ID 83404-5910
(208) 243-4595
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
5113
ID
Other
Enumeration date
04/29/2020
Last updated
04/29/2020
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