MEDICARE: JANE ATKINSON BOWER

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	2251P0200X	Pediatric Physical Therapist	40QA00223300	NJ
2	225100000X	Physical Therapist	26483	MD

General Provider Information

NPI Number	:	1942585203
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JANE ATKINSON BOWER

Provider Business Mailing Address
First Line	:	350 NEW FIDELITY CT
Second Line	:
City	:	GARNER
State	:	NC
Zip	:	27529-2665
Country	:	US
Telephone Number	:	919-258-2714
Fax Number	:	410-648-4878

Provider Business Practice Location Address
First Line	:	2540 PULASKI HWY STE B
Second Line	:
City	:	NORTH EAST
State	:	MD
Zip	:	21901-2610
Country	:	US
Telephone Number	:	410-339-1960
Fax Number	:	443-941-9441

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

Provider Enumeration Date	:	10/19/2011
Last Update Date	:	12/08/2020

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