Provider Demographics
NPI:1487959482
Name:BOWMAN, MARY (PT, DPT,OCS,LMT)
Entity type:Individual
Prefix:MRS
First Name:MARY
Middle Name:
Last Name:BOWMAN
Suffix:
Gender:F
Credentials:PT, DPT,OCS,LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3689 MELISSA CT NW
Mailing Address - Street 2:
Mailing Address - City:CORYDON
Mailing Address - State:IN
Mailing Address - Zip Code:47112-6277
Mailing Address - Country:US
Mailing Address - Phone:812-972-0877
Mailing Address - Fax:
Practice Address - Street 1:2363 HIGHWAY 135 NW
Practice Address - Street 2:117
Practice Address - City:CORYDON
Practice Address - State:IN
Practice Address - Zip Code:47112-2153
Practice Address - Country:US
Practice Address - Phone:812-734-1918
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-21
Last Update Date:2019-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY005747261QP2000X
IN05010942A225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy