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NPI Code Detail

MEDICARE: BECCA BOWEN CMT

MEDICARE: BECCA BOWEN CMT
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
1225700000XMassage Therapist92405CA

General Provider Information

NPI Number : 1811693476
Entity Type Code : Individual
Provider Name (Legal Business Name) : BECCA BOWEN CMT
Provider Business Mailing Address
First Line : 808 DONAHUE ST
Second Line :
City : SANTA ROSA
State : CA
Zip : 95401-5434
Country : US
Telephone Number : 707-322-6515
Fax Number :
Provider Business Practice Location Address
First Line : 808 DONAHUE ST
Second Line :
City : SANTA ROSA
State : CA
Zip : 95401-5434
Country : US
Telephone Number : 707-322-6515
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/06/2023
Last Update Date : 02/06/2023

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Directions to “ BECCA BOWEN CMT” Practice Location

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