Provider Demographics
NPI:1194947168
Name:BOWLIN, SCOTT
Entity type:Individual
Prefix:
First Name:SCOTT
Middle Name:
Last Name:BOWLIN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 TORREY PINE DR
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14612-2986
Mailing Address - Country:US
Mailing Address - Phone:585-225-0222
Mailing Address - Fax:
Practice Address - Street 1:2006 FIVE MILE LINE RD
Practice Address - Street 2:SUITE 117
Practice Address - City:PENFIELD
Practice Address - State:NY
Practice Address - Zip Code:14526-1419
Practice Address - Country:US
Practice Address - Phone:585-381-4128
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-02
Last Update Date:2009-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT22391225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist