Provider Demographics
NPI:1699355321
Name:BOWENS, RUBEN M
Entity Type:Individual
Prefix:
First Name:RUBEN
Middle Name:M
Last Name:BOWENS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:309 W MILLBROOK RD STE 131
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27609-4394
Mailing Address - Country:US
Mailing Address - Phone:919-896-7129
Mailing Address - Fax:
Practice Address - Street 1:309 W MILLBROOK RD STE 131
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27609-4394
Practice Address - Country:US
Practice Address - Phone:919-896-7129
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-08
Last Update Date:2021-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC15264225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist