Basic Information
| Provider Information | |||||||||
| NPI: | 1417082553 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | DOWELL | ||||||||
| FirstName: | THERESA | ||||||||
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| Credential: | P.T. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1515 E CEDAR AVE | ||||||||
| Address2: | STE C-1 | ||||||||
| City: | FLAGSTAFF | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 860041637 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9287741811 | ||||||||
| FaxNumber: | 9287742006 | ||||||||
| Practice Location | |||||||||
| Address1: | 1501 S YALE ST | ||||||||
| Address2: | STE# 252 | ||||||||
| City: | FLAGSTAFF | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 860017304 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9287741811 | ||||||||
| FaxNumber: | 9287742006 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/22/2007 | ||||||||
| LastUpdateDate: | 10/27/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 3278 | AZ | N | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | 363LF0000X | 4741 | AZ | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No ID Information.