Provider Demographics
NPI:1316503550
Name:BOWKER, SARA REBECCA (ATC)
Entity type:Individual
Prefix:MS
First Name:SARA
Middle Name:REBECCA
Last Name:BOWKER
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1806 E 2050 N
Mailing Address - Street 2:
Mailing Address - City:LAYTON
Mailing Address - State:UT
Mailing Address - Zip Code:84040-6701
Mailing Address - Country:US
Mailing Address - Phone:801-698-4652
Mailing Address - Fax:
Practice Address - Street 1:1806 E 2050 N
Practice Address - Street 2:
Practice Address - City:LAYTON
Practice Address - State:UT
Practice Address - Zip Code:84040-6701
Practice Address - Country:US
Practice Address - Phone:801-698-4652
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-14
Last Update Date:2019-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer