Individual
JESSICA FOWLER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PT, DPT
Contact information
Practice address
49443 VAN DYKE AVE, SHELBY TOWNSHIP, MI 48317-1310
(586) 580-8460
(586) 210-9626
Mailing address
2122 YORK RD STE 300, OAK BROOK, IL 60523-1925
(630) 575-6200
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
5501302439
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
5501302439
PHYSICAL THERPIST LICENSE
MI
Enumeration date
01/30/2023
Last updated
03/20/2026
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