Provider Demographics
NPI:1144642596
Name:FOWLER, TRISHA (LMT)
Entity type:Individual
Prefix:
First Name:TRISHA
Middle Name:
Last Name:FOWLER
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:TRISHA
Other - Middle Name:
Other - Last Name:TUCKER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMT
Mailing Address - Street 1:947 VISTA DR
Mailing Address - Street 2:
Mailing Address - City:GAHANNA
Mailing Address - State:OH
Mailing Address - Zip Code:43230-5965
Mailing Address - Country:US
Mailing Address - Phone:740-272-6409
Mailing Address - Fax:
Practice Address - Street 1:2000 KENNY RD
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43221-3555
Practice Address - Country:US
Practice Address - Phone:740-272-6409
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-01-19
Last Update Date:2016-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH33.011700225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist