Provider Demographics
NPI:1477961555
Name:BOWLES, BENJAMIN (ATC, LAT)
Entity Type:Individual
Prefix:
First Name:BENJAMIN
Middle Name:
Last Name:BOWLES
Suffix:
Gender:M
Credentials:ATC, LAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 S HURST RD
Mailing Address - Street 2:
Mailing Address - City:BURLESON
Mailing Address - State:TX
Mailing Address - Zip Code:76028-5006
Mailing Address - Country:US
Mailing Address - Phone:817-245-0384
Mailing Address - Fax:817-447-2151
Practice Address - Street 1:201 S HURST RD
Practice Address - Street 2:
Practice Address - City:BURLESON
Practice Address - State:TX
Practice Address - Zip Code:76028-5006
Practice Address - Country:US
Practice Address - Phone:817-245-0384
Practice Address - Fax:817-447-2151
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-01
Last Update Date:2014-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAT30812255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer