Ira Fowler Jr., PT
Individual provider Active NPI Physical Therapist · Ridgeland, MS
NPI 1093015232 · NPPES record last updated Oct 21, 2010
Key facts
- NPI
- 1093015232
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Physical Therapist 225100000X
- License
- PT0229 (MS)
- Practice address
- 711 Avignon Dr
Ridgeland, MS 39157-5120 - Phone
- (601) 605-6777
- Fax
- (601) 607-1389
- NPI assigned
- Oct 21, 2010
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PT0229 | MS | MD | Physical Therapist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Premier Medical Group of Mississippi LLC | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | PT0229 | MS | Yes |
Addresses
Primary practice location
711 Avignon Dr
Ridgeland, MS 39157-5120
Mailing address
711 Avignon Dr
Ridgeland, MS 39157-5120
Phone (601) 605-6777
Other providers in Ridgeland, MS
- Foot and Surgery Clinci, Inc
- Christe Tashay Ford McBride
- Forefront Dermatology, S.C.
- Forensic Psychological Services LLC
- Amanda F Fortenberry
- Olivia Montagnet Franklin
- Emily Brooks Freeman
- Taylor Lindsey Freeman
- Full Circle Counseling & Consulting
- Full Spectrum ABA of Mississippi LLC
All providers in Ridgeland, MS · Physical Therapist in Mississippi
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Oct 21, 2010. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.