Provider Demographics
NPI:1346489986
Name:BOWLING, WILLIAM RANDOLPH (PT, DPT)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:RANDOLPH
Last Name:BOWLING
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:RANDOLPH
Other - Middle Name:
Other - Last Name:BOWLING
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PT, DPT
Mailing Address - Street 1:6397 LEE HWY STE 300
Mailing Address - Street 2:
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37421-4915
Mailing Address - Country:US
Mailing Address - Phone:423-238-7217
Mailing Address - Fax:423-238-3473
Practice Address - Street 1:1409 HIGHWAY 62 65 N STE 4
Practice Address - Street 2:
Practice Address - City:HARRISON
Practice Address - State:AR
Practice Address - Zip Code:72601-1970
Practice Address - Country:US
Practice Address - Phone:870-704-4076
Practice Address - Fax:870-741-0089
Is Sole Proprietor?:No
Enumeration Date:2009-02-04
Last Update Date:2019-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA292480225100000X
OR06198225100000X
MO2010032120225100000X
TX1184200225100000X
NM3625225100000X
AR3094225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist