Individual
MR. IRA EDWARD FOWLER III
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
ATC
Contact information
Practice address
59 COLLEGE AVE, BUCKHANNON, WV 26201-2600
(304) 473-8349
Mailing address
180A JONES RD, WHEELERSBURG, OH 45694
(740) 961-7461
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
2000012772
—
Other
Enumeration date
02/25/2015
Last updated
02/25/2015
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