Provider Demographics
NPI:1245384700
Name:BOWEN, CARY BRECKINRIDGE II (PT)
Entity Type:Individual
Prefix:MR
First Name:CARY
Middle Name:BRECKINRIDGE
Last Name:BOWEN
Suffix:II
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3250 HARDEN STREET EXT
Mailing Address - Street 2:STE 200
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29203-6842
Mailing Address - Country:US
Mailing Address - Phone:803-509-6389
Mailing Address - Fax:803-509-6390
Practice Address - Street 1:3250 HARDEN STREET EXT
Practice Address - Street 2:STE 200
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29203-6842
Practice Address - Country:US
Practice Address - Phone:803-509-6389
Practice Address - Fax:803-509-6390
Is Sole Proprietor?:No
Enumeration Date:2007-01-22
Last Update Date:2012-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC4692225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist