MEDICARE: KESIA DANNER-BOWMAN PT

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	2251P0200X	Pediatric Physical Therapist	2003016259	MO
2	2251X0800X	Orthopedic Physical Therapist

General Provider Information

NPI Number	:	1336426386
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KESIA DANNER-BOWMAN PT

Provider Business Mailing Address
First Line	:	2898 S ELDON AVE
Second Line	:
City	:	SPRINGFIELD
State	:	MO
Zip	:	65807-5532
Country	:	US
Telephone Number	:	417-496-7638
Fax Number	:

Provider Business Practice Location Address
First Line	:	2898 S ELDON AVE
Second Line	:
City	:	SPRINGFIELD
State	:	MO
Zip	:	65807-5532
Country	:	US
Telephone Number	:	417-496-7638
Fax Number	:

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

Provider Enumeration Date	:	11/04/2011
Last Update Date	:	11/04/2011

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Directions to “ KESIA DANNER-BOWMAN PT” Practice Location

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