Provider Demographics
NPI:1609363779
Name:BOWMAN, NAM GIN PAUL
Entity Type:Individual
Prefix:
First Name:NAM GIN
Middle Name:PAUL
Last Name:BOWMAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1626 SASSAFRAS CT
Mailing Address - Street 2:
Mailing Address - City:FORT MILL
Mailing Address - State:SC
Mailing Address - Zip Code:29715-0183
Mailing Address - Country:US
Mailing Address - Phone:803-221-9699
Mailing Address - Fax:
Practice Address - Street 1:1099 EDGEWATER CORPORATE PKWY
Practice Address - Street 2:
Practice Address - City:INDIAN LAND
Practice Address - State:SC
Practice Address - Zip Code:29707-4516
Practice Address - Country:US
Practice Address - Phone:803-833-0077
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-15
Last Update Date:2018-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC3780225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant