Provider Demographics
NPI:1053444745
Name:BOWSER, JEANNE JEWELL (PT)
Entity Type:Individual
Prefix:
First Name:JEANNE
Middle Name:JEWELL
Last Name:BOWSER
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 1:402 CEDAR GROVE RD
Mailing Address - Street 2:
Mailing Address - City:EDGEWATER
Mailing Address - State:MD
Mailing Address - Zip Code:21037-2915
Mailing Address - Country:US
Mailing Address - Phone:410-956-0115
Mailing Address - Fax:410-956-5889
Practice Address - Street 1:1911 LINCOLN DR
Practice Address - Street 2:
Practice Address - City:ANNAPOLIS
Practice Address - State:MD
Practice Address - Zip Code:21401-4118
Practice Address - Country:US
Practice Address - Phone:410-573-1064
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-13
Last Update Date:2019-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD14727225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist