Provider Demographics
NPI:1679649172
Name:BOWEN, BRENDA BURKE (PT)
Entity Type:Individual
Prefix:MS
First Name:BRENDA
Middle Name:BURKE
Last Name:BOWEN
Suffix:
Gender:F
Credentials:PT
Other - Prefix:MS
Other - First Name:BRENDA
Other - Middle Name:CAROL
Other - Last Name:BOWEN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PT
Mailing Address - Street 1:801 WOOD VALLEY RD
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:36037
Mailing Address - Country:US
Mailing Address - Phone:334-383-0831
Mailing Address - Fax:
Practice Address - Street 1:801 WOOD VALLEY RD
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:AL
Practice Address - Zip Code:36037
Practice Address - Country:US
Practice Address - Phone:334-383-0831
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALPTH4148225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist