Provider Demographics
NPI:1730665506
Name:BOWEN, CHARICA M (MASSAGE THERAPIST)
Entity Type:Individual
Prefix:MS
First Name:CHARICA
Middle Name:M
Last Name:BOWEN
Suffix:
Gender:F
Credentials:MASSAGE THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2929 E 96TH ST STE D
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46240-1303
Mailing Address - Country:US
Mailing Address - Phone:317-986-0663
Mailing Address - Fax:
Practice Address - Street 1:2929 E 96TH ST STE D
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46240-1303
Practice Address - Country:US
Practice Address - Phone:317-986-0663
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-16
Last Update Date:2018-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
INMT20900910225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist