Provider Demographics
NPI:1992711923
Name:BOWEN, ANDREW THOMAS (PT)
Entity type:Individual
Prefix:MR
First Name:ANDREW
Middle Name:THOMAS
Last Name:BOWEN
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 1:24 CHELSEA RD
Mailing Address - Street 2:
Mailing Address - City:ESSEX JUNCTION
Mailing Address - State:VT
Mailing Address - Zip Code:05452-2615
Mailing Address - Country:US
Mailing Address - Phone:802-879-6049
Mailing Address - Fax:
Practice Address - Street 1:90 MAIN ST
Practice Address - Street 2:
Practice Address - City:BURLINGTON
Practice Address - State:VT
Practice Address - Zip Code:05401-8419
Practice Address - Country:US
Practice Address - Phone:802-861-6700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-31
Last Update Date:2012-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VTVT040-00034012251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT1007705Medicaid
VT6000628OtherMVP
VT5273607OtherVERMONT MANAGED CARE
VT69511OtherTVHP
VT49991OtherBLUE CROSS/ BLUE SHIELD
VT69511OtherTVHP