Provider Demographics
NPI:1851052666
Name:BOWDEN, NICOLE LYNN (LPTA)
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:LYNN
Last Name:BOWDEN
Suffix:
Gender:F
Credentials:LPTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5599 DABNEYS MILL RD
Mailing Address - Street 2:
Mailing Address - City:MANQUIN
Mailing Address - State:VA
Mailing Address - Zip Code:23106-2306
Mailing Address - Country:US
Mailing Address - Phone:757-371-4924
Mailing Address - Fax:
Practice Address - Street 1:1807 N PARHAM RD
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23229-4020
Practice Address - Country:US
Practice Address - Phone:804-967-0303
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-01-04
Last Update Date:2022-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2306605314225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant