Healthcare Provider Details

I. General information

NPI: 1184552721
Provider Name (Legal Business Name): TERRENCE BOWSER
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/13/2026
Last Update Date: 05/13/2026
Certification Date: 05/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22050 EASTSIDE DR APT 650
ASHBURN VA
20147-7236
US

IV. Provider business mailing address

22050 EASTSIDE DR APT 650
ASHBURN VA
20147-7236
US

V. Phone/Fax

Practice location:
  • Phone: 703-229-9590
  • Fax: 703-229-9590
Mailing address:
  • Phone: 703-229-9590
  • Fax: 703-229-9590

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171400000X
TaxonomyHealth & Wellness Coach
License Number61-2242984
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: