Individual
MR. JAMES MARK FOWLER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
P.T.
Contact information
Practice address
2005 W US ROUTE 66, SUITE C, MORIARTY, NM 87035
(505) 832-4011
(505) 832-0434
Mailing address
PO BOX 1730, MORIARTY, NM 87035-1730
(505) 832-4011
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
1036
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
H1865
—
NM
Enumeration date
11/17/2006
Last updated
01/31/2012
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