Healthcare Provider Details

I. General information

NPI: 1346489986
Provider Name (Legal Business Name): WILLIAM RANDOLPH BOWLING PT, DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: RANDOLPH BOWLING PT, DPT

II. Dates (important events)

Enumeration Date: 02/04/2009
Last Update Date: 06/27/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1409 HIGHWAY 62 65 N STE 4
HARRISON AR
72601-1970
US

IV. Provider business mailing address

6397 LEE HWY STE 300
CHATTANOOGA TN
37421-4915
US

V. Phone/Fax

Practice location:
  • Phone: 870-704-4076
  • Fax: 870-741-0089
Mailing address:
  • Phone: 423-238-7217
  • Fax: 423-238-3473

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number292480
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number06198
License Number StateOR
# 3
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number2010032120
License Number StateMO
# 4
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number1184200
License Number StateTX
# 5
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number3625
License Number StateNM
# 6
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number3094
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: