Provider Demographics
NPI:1063740173
Name:BOWMAN, JENNIFER STEELE (PT)
Entity type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:STEELE
Last Name:BOWMAN
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1506 E 29TH ST
Mailing Address - Street 2:
Mailing Address - City:TEXARKANA
Mailing Address - State:AR
Mailing Address - Zip Code:71854-2939
Mailing Address - Country:US
Mailing Address - Phone:870-216-7020
Mailing Address - Fax:
Practice Address - Street 1:1002 TEXAS BLVD
Practice Address - Street 2:SUITE 406
Practice Address - City:TEXARKANA
Practice Address - State:TX
Practice Address - Zip Code:75501-5107
Practice Address - Country:US
Practice Address - Phone:903-791-1111
Practice Address - Fax:903-794-4198
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-01
Last Update Date:2009-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1141901225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist