Provider Demographics
NPI:1235914409
Name:BOWYER, ABIGAIL (PTA)
Entity Type:Individual
Prefix:MISS
First Name:ABIGAIL
Middle Name:
Last Name:BOWYER
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1558 E BOULEVARD STE E
Mailing Address - Street 2:
Mailing Address - City:KOKOMO
Mailing Address - State:IN
Mailing Address - Zip Code:46902-2587
Mailing Address - Country:US
Mailing Address - Phone:765-865-8705
Mailing Address - Fax:765-875-8706
Practice Address - Street 1:1558 E BOULEVARD STE E
Practice Address - Street 2:
Practice Address - City:KOKOMO
Practice Address - State:IN
Practice Address - Zip Code:46902-2587
Practice Address - Country:US
Practice Address - Phone:765-865-8705
Practice Address - Fax:765-875-8706
Is Sole Proprietor?:No
Enumeration Date:2023-08-28
Last Update Date:2023-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN06006700A225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant