MEDICARE: MS. KRISTEN MARIE BOWMAN 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	34419	CA
2	225100000X	Physical Therapist	28021	FL

General Provider Information

NPI Number	:	1932366689
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. KRISTEN MARIE BOWMAN DPT

Provider Business Mailing Address
First Line	:	21281 GRAYTON TER
Second Line	:
City	:	PORT CHARLOTTE
State	:	FL
Zip	:	33954-3109
Country	:	US
Telephone Number	:	619-585-4080
Fax Number	:

Provider Business Practice Location Address
First Line	:	21281 GRAYTON TER
Second Line	:
City	:	PORT CHARLOTTE
State	:	FL
Zip	:	33954-3109
Country	:	US
Telephone Number	:	619-585-4080
Fax Number	:

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

Provider Enumeration Date	:	05/20/2008
Last Update Date	:	03/30/2016

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