Provider Demographics
NPI:1518440023
Name:BOWRON, EDWARD (DPT)
Entity Type:Individual
Prefix:
First Name:EDWARD
Middle Name:
Last Name:BOWRON
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:630 E 1ST ST
Mailing Address - Street 2:
Mailing Address - City:CASPER
Mailing Address - State:WY
Mailing Address - Zip Code:82601-2613
Mailing Address - Country:US
Mailing Address - Phone:307-266-4600
Mailing Address - Fax:307-266-4606
Practice Address - Street 1:630 E 1ST ST
Practice Address - Street 2:
Practice Address - City:CASPER
Practice Address - State:WY
Practice Address - Zip Code:82601-2613
Practice Address - Country:US
Practice Address - Phone:307-266-4600
Practice Address - Fax:307-266-4606
Is Sole Proprietor?:No
Enumeration Date:2018-09-11
Last Update Date:2023-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WYPT-2313225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist