Provider Demographics
NPI:1609951565
Name:BOWLES, COLIN P (DPT)
Entity Type:Individual
Prefix:
First Name:COLIN
Middle Name:P
Last Name:BOWLES
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 1:8705 DELTA ST
Mailing Address - Street 2:
Mailing Address - City:LA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:91942-3210
Mailing Address - Country:US
Mailing Address - Phone:619-460-0899
Mailing Address - Fax:
Practice Address - Street 1:4909 MURPHY CANYON RD
Practice Address - Street 2:STE 110
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92123-4349
Practice Address - Country:US
Practice Address - Phone:800-478-6856
Practice Address - Fax:800-863-2978
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT29539225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPT0295390Medicaid
CAWPT29539AMedicare ID - Type Unspecified