=====================================================
General NPI Number Information
=====================================================
NPI Number | 1821287236
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ELENA BOWEN LMT
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/22/2007
-----------------------------------------------------
Last Update Date | 10/22/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 18942 DALE MABRY HWY N SUITE 102
-----------------------------------------------------
City | LUTZ
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33548-4907
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 813-909-0961
-----------------------------------------------------
Fax | 813-909-2086
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 18942 DALE MABRY HWY N SUITE 102
-----------------------------------------------------
City | LUTZ
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33548-4907
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 813-909-0961
-----------------------------------------------------
Fax | 813-909-2086
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 174400000X
-----------------------------------------------------
Taxonomy Name | Specialist
-----------------------------------------------------
License Number | MA49885
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------