Provider Demographics
NPI:1063649952
Name:BOWLBY, ANNIE O (LMP)
Entity Type:Individual
Prefix:
First Name:ANNIE
Middle Name:O
Last Name:BOWLBY
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:138 ALPHA DR
Mailing Address - Street 2:
Mailing Address - City:LONGVIEW
Mailing Address - State:WA
Mailing Address - Zip Code:98632-5804
Mailing Address - Country:US
Mailing Address - Phone:360-501-6474
Mailing Address - Fax:
Practice Address - Street 1:1261 COMMERCE AVE STE 101
Practice Address - Street 2:
Practice Address - City:LONGVIEW
Practice Address - State:WA
Practice Address - Zip Code:98632-3090
Practice Address - Country:US
Practice Address - Phone:360-270-4214
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-17
Last Update Date:2009-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00007320172M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172M00000XOther Service ProvidersMechanotherapist