Provider Demographics
NPI:1821728726
Name:BOWMAN, HARTLEY NICOLE (PT, DPT)
Entity Type:Individual
Prefix:
First Name:HARTLEY
Middle Name:NICOLE
Last Name:BOWMAN
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:HARTLEY
Other - Middle Name:NICOLE
Other - Last Name:RUSSELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2656 S QUEBEC AVE
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74114-4830
Mailing Address - Country:US
Mailing Address - Phone:918-691-8129
Mailing Address - Fax:
Practice Address - Street 1:3345 S HARVARD AVE
Practice Address - Street 2:STE 101/301
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74135-1800
Practice Address - Country:US
Practice Address - Phone:918-574-2575
Practice Address - Fax:918-340-6632
Is Sole Proprietor?:No
Enumeration Date:2022-06-14
Last Update Date:2022-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK6205OtherOKLAHOMA MEDICAL BOARD PHYSICAL THERAPIST LICENSE NUMBER