Provider Demographics
NPI:1699198531
Name:BOWLBY, CARRIE LYNN (PTA)
Entity Type:Individual
Prefix:
First Name:CARRIE
Middle Name:LYNN
Last Name:BOWLBY
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:538 S 30TH ST
Mailing Address - Street 2:
Mailing Address - City:HEATH
Mailing Address - State:OH
Mailing Address - Zip Code:43056-1218
Mailing Address - Country:US
Mailing Address - Phone:740-270-9220
Mailing Address - Fax:
Practice Address - Street 1:1605 AIRPORT RD
Practice Address - Street 2:
Practice Address - City:NEW LEXINGTON
Practice Address - State:OH
Practice Address - Zip Code:43764-9749
Practice Address - Country:US
Practice Address - Phone:740-342-3502
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-01-29
Last Update Date:2014-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH08719225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant