MEDICARE: MR. KEITH A BOWYER JR. 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	PT16172	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	PT16172	OTHER	FL	FL LICENSE NUMBER

General Provider Information

NPI Number	:	1295712313
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. KEITH A BOWYER JR. P.T.

Provider Business Mailing Address
First Line	:	100 YMCA LN
Second Line	:
City	:	SEBRING
State	:	FL
Zip	:	33875-4352
Country	:	US
Telephone Number	:	863-382-2949
Fax Number	:	863-382-4732

Provider Business Practice Location Address
First Line	:	100 YMCA LN
Second Line	:
City	:	SEBRING
State	:	FL
Zip	:	33875-4352
Country	:	US
Telephone Number	:	863-382-2949
Fax Number	:	863-382-4732

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

Provider Enumeration Date	:	12/29/2005
Last Update Date	:	04/19/2012

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