MEDICARE: REBECCA L 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	225100000X	Physical Therapist	5501003957	MI

General Provider Information

NPI Number	:	1922292465
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	REBECCA L BOWMAN PT

Provider Business Mailing Address
First Line	:	11755 E MICHIGAN AVE
Second Line	:
City	:	GRASS LAKE
State	:	MI
Zip	:	49240-9219
Country	:	US
Telephone Number	:	517-234-3430
Fax Number	:	517-234-3430

Provider Business Practice Location Address
First Line	:	11755 E MICHIGAN AVE
Second Line	:
City	:	GRASS LAKE
State	:	MI
Zip	:	49240-9219
Country	:	US
Telephone Number	:	517-234-3430
Fax Number	:	517-234-3430

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

Provider Enumeration Date	:	08/28/2007
Last Update Date	:	08/01/2024

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