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General NPI Number Information
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NPI Number | 1538389689
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Entity Type | Individual
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Provider Name | KENNETH FRANKLIN BOWERSOX JR. LMT
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Gender | Male
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Dates
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Enumeration Date | 04/30/2007
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Last Update Date | 12/16/2014
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Provider Practice Location Address
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Address Line | 2445 LOCUST ST S
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City | CANAL FULTON
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State | OH
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Zip | 44614-9391
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Country | US
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Telephone | 330-687-4874
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Fax | 330-854-6571
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Provider Business Mailing Address
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Address Line | 2445 LOCUST ST S
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City | CANAL FULTON
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State | OH
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Zip | 44614-9391
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Country | US
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Telephone | 330-687-4874
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Fax | 330-854-6571
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225700000X
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Taxonomy Name | Massage Therapist
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License Number | 9964
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License Number State | OH
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