Provider Demographics
NPI:1063719144
Name:BOWLIN, JOHN WESLY (DPT)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:WESLY
Last Name:BOWLIN
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1463 17TH AVE
Mailing Address - Street 2:
Mailing Address - City:MITCHELL
Mailing Address - State:NE
Mailing Address - Zip Code:69357-1429
Mailing Address - Country:US
Mailing Address - Phone:308-623-1313
Mailing Address - Fax:
Practice Address - Street 1:1463 17TH AVE
Practice Address - Street 2:
Practice Address - City:MITCHELL
Practice Address - State:NE
Practice Address - Zip Code:69357-1429
Practice Address - Country:US
Practice Address - Phone:308-623-1313
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-02-25
Last Update Date:2016-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE2684225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist