Provider Demographics
NPI:1285942474
Name:BOWERS, KYLE WILLIAM (PT, DPT)
Entity type:Individual
Prefix:DR
First Name:KYLE
Middle Name:WILLIAM
Last Name:BOWERS
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2016 SOUTH MAIN STREET
Mailing Address - Street 2:
Mailing Address - City:MARYVILLE
Mailing Address - State:MO
Mailing Address - Zip Code:64468
Mailing Address - Country:US
Mailing Address - Phone:660-562-7908
Mailing Address - Fax:660-562-7967
Practice Address - Street 1:2016 SOUTH MAIN STREET
Practice Address - Street 2:
Practice Address - City:MARYVILLE
Practice Address - State:MO
Practice Address - Zip Code:64468
Practice Address - Country:US
Practice Address - Phone:660-562-7908
Practice Address - Fax:660-562-7967
Is Sole Proprietor?:No
Enumeration Date:2010-09-22
Last Update Date:2010-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2010027997225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist