Healthcare Provider Details

I. General information

NPI: 1407822471
Provider Name (Legal Business Name): KASANDRA BOWLES ST. CLAIR D.P.T.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/28/2006
Last Update Date: 04/15/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1901 S MAIN ST SUITE 8
BLACKSBURG VA
24060-6600
US

IV. Provider business mailing address

1901 S MAIN ST SUITE 8
BLACKSBURG VA
24060-6600
US

V. Phone/Fax

Practice location:
  • Phone: 540-552-3422
  • Fax: 540-552-2296
Mailing address:
  • Phone: 540-552-3422
  • Fax: 540-552-2296

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number2305204384
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: