Provider Demographics
NPI:1255316469
Name:BOWMAN, ALAN L (PT)
Entity Type:Individual
Prefix:
First Name:ALAN
Middle Name:L
Last Name:BOWMAN
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 3497
Mailing Address - Street 2:
Mailing Address - City:STURTEVANT
Mailing Address - State:WI
Mailing Address - Zip Code:53177-0300
Mailing Address - Country:US
Mailing Address - Phone:877-552-2996
Mailing Address - Fax:866-245-8064
Practice Address - Street 1:10342 DYNO DR
Practice Address - Street 2:SUITE 2
Practice Address - City:HAYWARD
Practice Address - State:WI
Practice Address - Zip Code:54843-6150
Practice Address - Country:US
Practice Address - Phone:715-699-1371
Practice Address - Fax:866-245-8064
Is Sole Proprietor?:No
Enumeration Date:2005-12-09
Last Update Date:2010-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI5868024225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1255316469Medicaid
WI40389300Medicaid
WI40389300Medicaid
WI800500012Medicare PIN