MEDICARE: LAURA C BOWEN 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	225100000X	Physical Therapist	3661	NM

General Provider Information

NPI Number	:	1699917658
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LAURA C BOWEN PT

Provider Business Mailing Address
First Line	:	3832 E MAIN ST
Second Line	:	UNITS E & F
City	:	FARMINGTON
State	:	NM
Zip	:	87402-8749
Country	:	US
Telephone Number	:	505-564-2955
Fax Number	:	505-564-2662

Provider Business Practice Location Address
First Line	:	3832 E MAIN ST
Second Line	:	UNITS E & F
City	:	FARMINGTON
State	:	NM
Zip	:	87402-8749
Country	:	US
Telephone Number	:	505-564-2955
Fax Number	:	505-564-2662

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

Provider Enumeration Date	:	04/06/2009
Last Update Date	:	04/06/2009

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Directions to “ LAURA C BOWEN PT” Practice Location

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