Healthcare Provider Details

I. General information

NPI: 1346529385
Provider Name (Legal Business Name): BRETT BOWMAN PT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/09/2011
Last Update Date: 05/28/2025
Certification Date: 05/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 EASTSIDE DR STE D
GEORGETOWN KY
40324-8763
US

IV. Provider business mailing address

901 BROOMFIELD TRL
ELIZABETH CITY NC
27909-7040
US

V. Phone/Fax

Practice location:
  • Phone: 502-867-0111
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number007877
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number4625
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: