Healthcare Provider Details

I. General information

NPI: 1457397366
Provider Name (Legal Business Name): H TOM BOWDEN PT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/20/2006
Last Update Date: 04/19/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

202 WEST 7TH ST MEDICAL ARTS BLDG STE 117
LONDON KY
40741
US

IV. Provider business mailing address

PO BOX 911148
LEXINGTON KY
40591-1148
US

V. Phone/Fax

Practice location:
  • Phone: 606-864-7316
  • Fax: 606-878-0590
Mailing address:
  • Phone: 859-278-2121
  • Fax: 859-276-2795

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number000379
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: