Provider Demographics
NPI:1639128481
Name:BOWIE PHYSICAL THERAPY & SPORTS MEDICINE PC
Entity Type:Organization
Organization Name:BOWIE PHYSICAL THERAPY & SPORTS MEDICINE PC
Other - Org Name:BOWIE PHYSICAL THERAPY & SPORTS MEDICINE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER DIRECTOR OF PT
Authorized Official - Prefix:MR
Authorized Official - First Name:DANNY
Authorized Official - Middle Name:BAXTER
Authorized Official - Last Name:LAWS
Authorized Official - Suffix:
Authorized Official - Credentials:LPT
Authorized Official - Phone:940-872-6852
Mailing Address - Street 1:1111 E WISE ST
Mailing Address - Street 2:
Mailing Address - City:BOWIE
Mailing Address - State:TX
Mailing Address - Zip Code:76230-4516
Mailing Address - Country:US
Mailing Address - Phone:940-872-6852
Mailing Address - Fax:940-872-6859
Practice Address - Street 1:1111 E WISE ST
Practice Address - Street 2:
Practice Address - City:BOWIE
Practice Address - State:TX
Practice Address - Zip Code:76230-4516
Practice Address - Country:US
Practice Address - Phone:940-872-6852
Practice Address - Fax:940-872-6859
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-09
Last Update Date:2009-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1008498225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8T2662OtherBLUE CROSS BLUE SHEILD
TX0029LJOtherBC BS GROUP
TX1079816-01Medicaid
TX686183OtherACN GROUP
TX686183OtherACN GROUP