Provider Demographics
NPI:1598901985
Name:BOWLES, COREY ALISON (ATC, VATL, EMT)
Entity Type:Individual
Prefix:MRS
First Name:COREY
Middle Name:ALISON
Last Name:BOWLES
Suffix:
Gender:F
Credentials:ATC, VATL, EMT
Other - Prefix:MISS
Other - First Name:COREY
Other - Middle Name:ALISON
Other - Last Name:MCNANLEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ATC, VATL
Mailing Address - Street 1:2936 S FORREST AVE
Mailing Address - Street 2:
Mailing Address - City:COVINGTON
Mailing Address - State:VA
Mailing Address - Zip Code:24426-2912
Mailing Address - Country:US
Mailing Address - Phone:540-962-5149
Mailing Address - Fax:540-863-1705
Practice Address - Street 1:210 MOUNTAINEER DR
Practice Address - Street 2:
Practice Address - City:COVINGTON
Practice Address - State:VA
Practice Address - Zip Code:24426-6331
Practice Address - Country:US
Practice Address - Phone:540-863-1700
Practice Address - Fax:540-863-1705
Is Sole Proprietor?:No
Enumeration Date:2009-01-06
Last Update Date:2009-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VAB081110705146N00000X
VA01260008902255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
No146N00000XEmergency Medical Service ProvidersEmergency Medical Technician, Basic