Healthcare Provider Details

I. General information

NPI: 1588897615
Provider Name (Legal Business Name): NICOLE HELENA BOWER D.P.T., CSCS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/24/2009
Last Update Date: 05/30/2026
Certification Date: 05/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

69472 SERENITY RD
CATHEDRAL CITY CA
92234-7921
US

IV. Provider business mailing address

69472 SERENITY RD
CATHEDRAL CITY CA
92234-7921
US

V. Phone/Fax

Practice location:
  • Phone: 603-491-2331
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number35936
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: