Healthcare Provider Details

I. General information

NPI: 1932448511
Provider Name (Legal Business Name): DAWN M BOWMAN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/02/2013
Last Update Date: 02/02/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

208 PENNKNOLL RD
EVERETT PA
15537-6940
US

IV. Provider business mailing address

48 N SPRING ST
EVERETT PA
15537-1160
US

V. Phone/Fax

Practice location:
  • Phone: 814-623-3200
  • Fax:
Mailing address:
  • Phone: 814-652-9323
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License NumberTEI003399
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: