Provider Demographics
NPI:1699917658
Name:BOWEN, LAURA C (PT)
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:C
Last Name:BOWEN
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3832 E MAIN ST
Mailing Address - Street 2:UNITS E & F
Mailing Address - City:FARMINGTON
Mailing Address - State:NM
Mailing Address - Zip Code:87402-8749
Mailing Address - Country:US
Mailing Address - Phone:505-564-2955
Mailing Address - Fax:505-564-2662
Practice Address - Street 1:3832 E MAIN ST
Practice Address - Street 2:UNITS E & F
Practice Address - City:FARMINGTON
Practice Address - State:NM
Practice Address - Zip Code:87402-8749
Practice Address - Country:US
Practice Address - Phone:505-564-2955
Practice Address - Fax:505-564-2662
Is Sole Proprietor?:No
Enumeration Date:2009-04-06
Last Update Date:2009-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM3661225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist