Healthcare Provider Details

I. General information

NPI: 1578489563
Provider Name (Legal Business Name): MATTHEW BOWLER
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/25/2026
Last Update Date: 09/02/2026
Certification Date: 09/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

140 NUTT RD
PHOENIXVILLE PA
19460-3906
US

IV. Provider business mailing address

3462 TILDEN ST
PHILADELPHIA PA
19129-1435
US

V. Phone/Fax

Practice location:
  • Phone: 267-825-4422
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License NumberSC007672
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: