Healthcare Provider Details

I. General information

NPI: 1942585203
Provider Name (Legal Business Name): JANE ATKINSON BOWER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/19/2011
Last Update Date: 12/08/2020
Certification Date: 12/08/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2540 PULASKI HWY STE B
NORTH EAST MD
21901-2610
US

IV. Provider business mailing address

350 NEW FIDELITY CT
GARNER NC
27529-2665
US

V. Phone/Fax

Practice location:
  • Phone: 410-339-1960
  • Fax: 443-941-9441
Mailing address:
  • Phone: 919-258-2714
  • Fax: 410-648-4878

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number26483
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code2251P0200X
TaxonomyPediatric Physical Therapist
License Number40QA00223300
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: