Provider Demographics
NPI:1003160458
Name:BOWLIN, TINA (LMT)
Entity Type:Individual
Prefix:
First Name:TINA
Middle Name:
Last Name:BOWLIN
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:947 MYRTLE CT
Mailing Address - Street 2:
Mailing Address - City:MOUNT PLEASANT
Mailing Address - State:SC
Mailing Address - Zip Code:29464-4526
Mailing Address - Country:US
Mailing Address - Phone:646-621-6156
Mailing Address - Fax:
Practice Address - Street 1:947 MYRTLE CT
Practice Address - Street 2:
Practice Address - City:MOUNT PLEASANT
Practice Address - State:SC
Practice Address - Zip Code:29464-4526
Practice Address - Country:US
Practice Address - Phone:646-621-6156
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-07
Last Update Date:2012-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies