MEDICARE: CHARLES BOUWENS RPT

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	PT8092	FL

General Provider Information

NPI Number	:	1295075257
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHARLES BOUWENS RPT

Provider Business Mailing Address
First Line	:	2991 ELDER CT
Second Line	:
City	:	PALM HARBOR
State	:	FL
Zip	:	34684-3612
Country	:	US
Telephone Number	:	727-786-3649
Fax Number	:

Provider Business Practice Location Address
First Line	:	26837 TANIC DR
Second Line	:	SUITE 101
City	:	WESLEY CHAPEL
State	:	FL
Zip	:	33544-4613
Country	:	US
Telephone Number	:	813-527-6913
Fax Number	:

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

Provider Enumeration Date	:	02/27/2013
Last Update Date	:	02/27/2013

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