Provider Demographics
NPI:1144278250
Name:FOWLER, ANTONIA A (PT)
Entity type:Individual
Prefix:
First Name:ANTONIA
Middle Name:A
Last Name:FOWLER
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11620 COBRA AVE
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99507-6336
Mailing Address - Country:US
Mailing Address - Phone:907-346-3090
Mailing Address - Fax:
Practice Address - Street 1:3500 LATOUCHE ST
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99508-4261
Practice Address - Country:US
Practice Address - Phone:907-292-2567
Practice Address - Fax:907-929-2922
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AKAA238225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AK126994Medicare ID - Type UnspecifiedMEDICARE