Provider Demographics
NPI:1760012520
Name:BOWEN, LORIAN ALESHIA
Entity Type:Individual
Prefix:
First Name:LORIAN
Middle Name:ALESHIA
Last Name:BOWEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8864 SW 129TH TER STE B
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33176-5931
Mailing Address - Country:US
Mailing Address - Phone:786-438-6642
Mailing Address - Fax:
Practice Address - Street 1:8864 SW 129TH TER STE B
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33176-5931
Practice Address - Country:US
Practice Address - Phone:786-438-6642
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-21
Last Update Date:2020-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA87359225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLB500-521-88-757-1OtherDRIVERS LICENSE