MEDICARE: MRS. ALETHA P BOWEN 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	PTA265	AL

General Provider Information

NPI Number	:	1710113931
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. ALETHA P BOWEN LPTA

Provider Business Mailing Address
First Line	:	797 COUNTY ROAD 112
Second Line	:
City	:	FORT PAYNE
State	:	AL
Zip	:	35968-6344
Country	:	US
Telephone Number	:	256-657-3915
Fax Number	:

Provider Business Practice Location Address
First Line	:	797 COUNTY ROAD 112
Second Line	:
City	:	FORT PAYNE
State	:	AL
Zip	:	35968-6344
Country	:	US
Telephone Number	:	256-657-3915
Fax Number	:

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

Provider Enumeration Date	:	06/02/2009
Last Update Date	:	06/02/2009

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