Healthcare Provider Details

I. General information

NPI: 1831892470
Provider Name (Legal Business Name): BROOKE AUTUMN BOWMAN MPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/23/2023
Last Update Date: 04/03/2026
Certification Date: 04/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1910 BLANDING ST
COLUMBIA SC
29201-3520
US

IV. Provider business mailing address

915 HOOK AVE
WEST COLUMBIA SC
29169-5332
US

V. Phone/Fax

Practice location:
  • Phone: 803-256-4107
  • Fax:
Mailing address:
  • Phone: 803-926-8600
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number5278
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: