Provider Demographics
NPI:1841609914
Name:BOWNE, NICHOLAS CHRISTOPHER (DPT)
Entity Type:Individual
Prefix:
First Name:NICHOLAS
Middle Name:CHRISTOPHER
Last Name:BOWNE
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:430 INNOVATION DRIVE
Mailing Address - Street 2:
Mailing Address - City:BLAIRSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:15717-8096
Mailing Address - Country:US
Mailing Address - Phone:724-343-4060
Mailing Address - Fax:724-343-4069
Practice Address - Street 1:127 N MAIN ST
Practice Address - Street 2:NORTHERN TIER PROFESSIONAL BUILDING
Practice Address - City:MANSFIELD
Practice Address - State:PA
Practice Address - Zip Code:16933-1305
Practice Address - Country:US
Practice Address - Phone:570-666-2317
Practice Address - Fax:570-662-3269
Is Sole Proprietor?:No
Enumeration Date:2014-08-04
Last Update Date:2015-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT023851225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA396749Medicare PIN