Provider Demographics
NPI:1649209362
Name:BOWYER PHYSICAL THERAPY INC
Entity Type:Organization
Organization Name:BOWYER PHYSICAL THERAPY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:KEITH
Authorized Official - Middle Name:ANTHONY
Authorized Official - Last Name:BOWYER
Authorized Official - Suffix:JR
Authorized Official - Credentials:PT
Authorized Official - Phone:863-382-2949
Mailing Address - Street 1:100 YMCA LN
Mailing Address - Street 2:
Mailing Address - City:SEBRING
Mailing Address - State:FL
Mailing Address - Zip Code:33875-4352
Mailing Address - Country:US
Mailing Address - Phone:863-382-2949
Mailing Address - Fax:
Practice Address - Street 1:100 YMCA LN
Practice Address - Street 2:
Practice Address - City:SEBRING
Practice Address - State:FL
Practice Address - Zip Code:33875-4352
Practice Address - Country:US
Practice Address - Phone:863-382-2949
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-03
Last Update Date:2012-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT16172225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
Q0204Medicare PIN