Provider Demographics
NPI:1245606656
Name:BOWMAN, ANDREA (LMP)
Entity Type:Individual
Prefix:
First Name:ANDREA
Middle Name:
Last Name:BOWMAN
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 1:9889 CENTRAL VALLEY RD NW
Mailing Address - Street 2:
Mailing Address - City:BREMERTON
Mailing Address - State:WA
Mailing Address - Zip Code:98311-9131
Mailing Address - Country:US
Mailing Address - Phone:360-692-7321
Mailing Address - Fax:360-692-1718
Practice Address - Street 1:13333 MERIDIAN E
Practice Address - Street 2:STE H
Practice Address - City:PUYALLUP
Practice Address - State:WA
Practice Address - Zip Code:98373-2405
Practice Address - Country:US
Practice Address - Phone:253-200-4401
Practice Address - Fax:253-200-4402
Is Sole Proprietor?:No
Enumeration Date:2015-08-19
Last Update Date:2015-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60558837225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist