Provider Demographics
NPI:1689272635
Name:BOW, EILEEN (PT)
Entity Type:Individual
Prefix:
First Name:EILEEN
Middle Name:
Last Name:BOW
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:EILEEN
Other - Middle Name:
Other - Last Name:BOW
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PT
Mailing Address - Street 1:13 PARK LAWN DR
Mailing Address - Street 2:
Mailing Address - City:BETHEL
Mailing Address - State:CT
Mailing Address - Zip Code:06801-1043
Mailing Address - Country:US
Mailing Address - Phone:203-790-8520
Mailing Address - Fax:203-790-8530
Practice Address - Street 1:13 PARK LAWN DR
Practice Address - Street 2:
Practice Address - City:BETHEL
Practice Address - State:CT
Practice Address - Zip Code:06801-1043
Practice Address - Country:US
Practice Address - Phone:203-790-8520
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-13
Last Update Date:2020-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
005311225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist