Provider Demographics
NPI:1649411943
Name:DOWLING, BEVERLY JANE (PT)
Entity Type:Individual
Prefix:
First Name:BEVERLY
Middle Name:JANE
Last Name:DOWLING
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 217
Mailing Address - Street 2:
Mailing Address - City:FORT JONES
Mailing Address - State:CA
Mailing Address - Zip Code:96032-0217
Mailing Address - Country:US
Mailing Address - Phone:530-468-5528
Mailing Address - Fax:
Practice Address - Street 1:122 SCOTT RIVER RD
Practice Address - Street 2:
Practice Address - City:FORT JONES
Practice Address - State:CA
Practice Address - Zip Code:96032-9620
Practice Address - Country:US
Practice Address - Phone:530-468-5528
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-16
Last Update Date:2009-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT9004225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CABV919ZOtherMEDICARE PTAN