Provider Demographics
NPI:1417111345
Name:BOWMAN, MYRLYNN HENLEY
Entity Type:Individual
Prefix:
First Name:MYRLYNN
Middle Name:HENLEY
Last Name:BOWMAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15600 SAN PEDRO AVE
Mailing Address - Street 2:SUITE 307
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78232-3740
Mailing Address - Country:US
Mailing Address - Phone:210-494-2343
Mailing Address - Fax:
Practice Address - Street 1:15600 SAN PEDRO AVE
Practice Address - Street 2:SUITE 307
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78232-3740
Practice Address - Country:US
Practice Address - Phone:210-494-2343
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-10
Last Update Date:2008-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX08081903225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant