Provider Demographics
NPI:1346637279
Name:BOWERS, ROBERT GAMBLE JR (ATC)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:GAMBLE
Last Name:BOWERS
Suffix:JR
Gender:M
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13010 PASEO LUCIDO
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92128-4478
Mailing Address - Country:US
Mailing Address - Phone:858-485-4800
Mailing Address - Fax:858-485-4817
Practice Address - Street 1:13010 PASEO LUCIDO
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92128-4478
Practice Address - Country:US
Practice Address - Phone:858-485-4800
Practice Address - Fax:858-485-4817
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-17
Last Update Date:2021-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer