Provider Demographics
NPI:1326003880
Name:BOWERS, JEFFREY (MS MPT ATC)
Entity Type:Individual
Prefix:MR
First Name:JEFFREY
Middle Name:
Last Name:BOWERS
Suffix:
Gender:M
Credentials:MS MPT ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7351 PRAIRIE FALCON RD
Mailing Address - Street 2:STE 100
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89128
Mailing Address - Country:US
Mailing Address - Phone:702-968-0520
Mailing Address - Fax:702-968-0521
Practice Address - Street 1:7351 PRAIRIE FALCON RD
Practice Address - Street 2:STE 100
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89128
Practice Address - Country:US
Practice Address - Phone:702-968-0520
Practice Address - Fax:702-968-0521
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV1026225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV3402207Medicaid
NV3402207Medicaid