Provider Demographics
NPI:1215386230
Name:BOWEN, ALAN WADE (ATC)
Entity type:Individual
Prefix:
First Name:ALAN
Middle Name:WADE
Last Name:BOWEN
Suffix:
Gender:M
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1040 GULF BREEZE PKWY STE 200
Mailing Address - Street 2:
Mailing Address - City:GULF BREEZE
Mailing Address - State:FL
Mailing Address - Zip Code:32561-7808
Mailing Address - Country:US
Mailing Address - Phone:508-916-3715
Mailing Address - Fax:
Practice Address - Street 1:1925 DON WICKHAM DR
Practice Address - Street 2:
Practice Address - City:CLERMONT
Practice Address - State:FL
Practice Address - Zip Code:34711-1915
Practice Address - Country:US
Practice Address - Phone:352-404-8956
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-09
Last Update Date:2020-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer