Provider Demographics
NPI:1851763445
Name:BOWEN, STEVEN PATRICK (PT)
Entity Type:Individual
Prefix:
First Name:STEVEN
Middle Name:PATRICK
Last Name:BOWEN
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:PATRICK
Other - Middle Name:
Other - Last Name:BOWEN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PT
Mailing Address - Street 1:3410 MAGNOLIA ST
Mailing Address - Street 2:
Mailing Address - City:TEXARKANA
Mailing Address - State:TX
Mailing Address - Zip Code:75503-3729
Mailing Address - Country:US
Mailing Address - Phone:903-792-3003
Mailing Address - Fax:903-794-1005
Practice Address - Street 1:3410 MAGNOLIA ST
Practice Address - Street 2:
Practice Address - City:TEXARKANA
Practice Address - State:TX
Practice Address - Zip Code:75503-3729
Practice Address - Country:US
Practice Address - Phone:903-792-3003
Practice Address - Fax:903-794-1005
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-22
Last Update Date:2015-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1212312225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist