MEDICARE: STACY ANN BOWERS DPT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	23721	MD
2	225100000X	Physical Therapist	PT021003	PA
3	225100000X	Physical Therapist	10957	AZ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1265720239
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STACY ANN BOWERS DPT

Provider Business Mailing Address
First Line	:	41818 N VENTURE DR
Second Line	:	SUITE 120
City	:	ANTHEM
State	:	AZ
Zip	:	85086-3188
Country	:	US
Telephone Number	:	623-742-7338
Fax Number	:	623-742-7339

Provider Business Practice Location Address
First Line	:	41818 N VENTURE DR
Second Line	:	SUITE 120
City	:	ANTHEM
State	:	AZ
Zip	:	85086-3188
Country	:	US
Telephone Number	:	623-742-7338
Fax Number	:	623-742-7339

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/12/2011
Last Update Date	:	02/05/2015

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Directions to “ STACY ANN BOWERS DPT” Practice Location

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