Provider Demographics
NPI:1790980787
Name:BOWMAN, REBECCA LYNN
Entity Type:Individual
Prefix:MRS
First Name:REBECCA
Middle Name:LYNN
Last Name:BOWMAN
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:PO BOX 2328
Mailing Address - Street 2:
Mailing Address - City:LONDON
Mailing Address - State:KY
Mailing Address - Zip Code:40743-2328
Mailing Address - Country:US
Mailing Address - Phone:606-877-3950
Mailing Address - Fax:606-877-3956
Practice Address - Street 1:740 E LAUREL RD
Practice Address - Street 2:
Practice Address - City:LONDON
Practice Address - State:KY
Practice Address - Zip Code:40741-8601
Practice Address - Country:US
Practice Address - Phone:606-877-3950
Practice Address - Fax:606-877-3956
Is Sole Proprietor?:No
Enumeration Date:2007-06-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY003579225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY003579OtherSTATE LICENSE