MEDICARE: LISA BOWARD LPTA

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	225200000X	Physical Therapy Assistant	PTA 001705	WV
2	225200000X	Physical Therapy Assistant	2306604354	VA

General Provider Information

NPI Number	:	1427580984
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LISA BOWARD LPTA

Provider Business Mailing Address
First Line	:	407 OFFUTT SCHOOL RD
Second Line	:
City	:	AUGUSTA
State	:	WV
Zip	:	26704-7279
Country	:	US
Telephone Number	:	304-268-7611
Fax Number	:

Provider Business Practice Location Address
First Line	:	407 OFFUTT SCHOOL ROAD
Second Line	:
City	:	AUGUSTA
State	:	WV
Zip	:	26704
Country	:	US
Telephone Number	:	304-268-7611
Fax Number	:

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

Provider Enumeration Date	:	04/03/2017
Last Update Date	:	04/03/2017

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