Provider Demographics
NPI:1285665497
Name:BOWER, CHARLES MARTIN (ATC)
Entity type:Individual
Prefix:MR
First Name:CHARLES
Middle Name:MARTIN
Last Name:BOWER
Suffix:
Gender:M
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:5425 S HONEYSUCKLE LN
Mailing Address - Street 2:
Mailing Address - City:BATTLEFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65619-9350
Mailing Address - Country:US
Mailing Address - Phone:417-209-4829
Mailing Address - Fax:417-269-5508
Practice Address - Street 1:3545 S NATIONAL AVE
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MO
Practice Address - Zip Code:65807-7310
Practice Address - Country:US
Practice Address - Phone:417-988-5071
Practice Address - Fax:417-269-5508
Is Sole Proprietor?:No
Enumeration Date:2006-07-05
Last Update Date:2008-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20050080422255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer