Provider Demographics
NPI:1316218506
Name:BOWHALL, ROBERT ALLEN (LMT, MMP)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:ALLEN
Last Name:BOWHALL
Suffix:
Gender:M
Credentials:LMT, MMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 N FAIR ST
Mailing Address - Street 2:P.O. BOX 4
Mailing Address - City:MORRISON
Mailing Address - State:TN
Mailing Address - Zip Code:37357-5730
Mailing Address - Country:US
Mailing Address - Phone:931-743-6337
Mailing Address - Fax:
Practice Address - Street 1:200 N FAIR ST
Practice Address - Street 2:
Practice Address - City:MORRISON
Practice Address - State:TN
Practice Address - Zip Code:37357-5730
Practice Address - Country:US
Practice Address - Phone:931-743-6337
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-01-19
Last Update Date:2014-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN0000008281172M00000X, 225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
No172M00000XOther Service ProvidersMechanotherapist