Healthcare Provider Details

I. General information

NPI: 1992628382
Provider Name (Legal Business Name): BOWEN ZHANG
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/03/2026
Last Update Date: 08/03/2026
Certification Date: 08/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

440 N CAMINO MERCADO STE 8
CASA GRANDE AZ
85122-5750
US

IV. Provider business mailing address

255 N CAMINO MERCADO APT 2070
CASA GRANDE AZ
85122-5769
US

V. Phone/Fax

Practice location:
  • Phone: 512-839-3391
  • Fax:
Mailing address:
  • Phone: 512-839-3391
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberLPT-034881
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: