Provider Demographics
NPI:1093889990
Name:BOWIE PHYSICAL THERAPY ASSOCIATES INC
Entity Type:Organization
Organization Name:BOWIE PHYSICAL THERAPY ASSOCIATES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO DIRECTOR OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:MARY
Authorized Official - Middle Name:JANE
Authorized Official - Last Name:FERNANADEZ
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:301-464-1893
Mailing Address - Street 1:4351 NORTHVIEW DRIVE
Mailing Address - Street 2:
Mailing Address - City:BOWIE
Mailing Address - State:MD
Mailing Address - Zip Code:20716-2602
Mailing Address - Country:US
Mailing Address - Phone:301-464-1489
Mailing Address - Fax:301-464-1824
Practice Address - Street 1:4351 NORTHVIEW DRIVE
Practice Address - Street 2:
Practice Address - City:BOWIE
Practice Address - State:MD
Practice Address - Zip Code:20716-2602
Practice Address - Country:US
Practice Address - Phone:301-464-1489
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-20
Last Update Date:2008-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
DCS891OtherCAREFIRST
MDH379OtherCAREFIRST
G01134Medicare ID - Type Unspecified