Provider Demographics
NPI:1427125178
Name:BOWLING, GREGORY S (PT)
Entity type:Individual
Prefix:
First Name:GREGORY
Middle Name:S
Last Name:BOWLING
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6433 RT 60 EAST
Mailing Address - Street 2:SUITE 125
Mailing Address - City:BARBOURSVILLE
Mailing Address - State:WV
Mailing Address - Zip Code:25504
Mailing Address - Country:US
Mailing Address - Phone:304-736-3094
Mailing Address - Fax:304-736-3149
Practice Address - Street 1:6433 RT 60 EAST
Practice Address - Street 2:SUITE 125
Practice Address - City:BARBOURSVILLE
Practice Address - State:WV
Practice Address - Zip Code:25504
Practice Address - Country:US
Practice Address - Phone:304-736-3094
Practice Address - Fax:304-736-3149
Is Sole Proprietor?:No
Enumeration Date:2006-11-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV001076225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0156741000Medicaid
WV0156741000Medicaid