Healthcare Provider Details

I. General information

NPI: 1699576785
Provider Name (Legal Business Name): TYNA BOWENS MS, EP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/24/2025
Last Update Date: 03/24/2025
Certification Date: 03/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

230 E OHIO ST STE 410
CHICAGO IL
60611-5288
US

IV. Provider business mailing address

230 E OHIO ST STE 410
CHICAGO IL
60611-5288
US

V. Phone/Fax

Practice location:
  • Phone: 872-339-7576
  • Fax:
Mailing address:
  • Phone: 872-339-7576
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Y00000X
TaxonomyClinical Exercise Physiologist
License Number1067837
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: