MEDICARE: ALAN L BOWMAN P.T.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	5868024	WI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1255316469
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALAN L BOWMAN P.T.

Provider Business Mailing Address
First Line	:	PO BOX 3497
Second Line	:
City	:	STURTEVANT
State	:	WI
Zip	:	53177-0300
Country	:	US
Telephone Number	:	877-552-2996
Fax Number	:	866-245-8064

Provider Business Practice Location Address
First Line	:	10342 DYNO DR
Second Line	:	SUITE 2
City	:	HAYWARD
State	:	WI
Zip	:	54843-6150
Country	:	US
Telephone Number	:	715-699-1371
Fax Number	:	866-245-8064

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/09/2005
Last Update Date	:	09/27/2010

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