Provider Demographics
NPI:1275500803
Name:BOWDEN, CHARLA ANN (PT)
Entity Type:Individual
Prefix:MRS
First Name:CHARLA
Middle Name:ANN
Last Name:BOWDEN
Suffix:
Gender:F
Credentials:PT
Other - Prefix:MRS
Other - First Name:CHARLA
Other - Middle Name:ANN
Other - Last Name:BROOKS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:1232 EAST DEER RIDGE
Mailing Address - Street 2:
Mailing Address - City:BRANDON
Mailing Address - State:MS
Mailing Address - Zip Code:39042
Mailing Address - Country:US
Mailing Address - Phone:601-825-9450
Mailing Address - Fax:
Practice Address - Street 1:1058 HOLLAND AVE
Practice Address - Street 2:PHILADELPHIA PHYSICAL THERAPY
Practice Address - City:PHILADELPHIA
Practice Address - State:MS
Practice Address - Zip Code:39350
Practice Address - Country:US
Practice Address - Phone:601-650-9111
Practice Address - Fax:601-650-1972
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSPT1020225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist