Provider Demographics
NPI:1942320825
Name:BOWE, THIAM (CRTP, LMT)
Entity Type:Individual
Prefix:
First Name:THIAM
Middle Name:
Last Name:BOWE
Suffix:
Gender:F
Credentials:CRTP, LMT
Other - Prefix:
Other - First Name:THIAM
Other - Middle Name:
Other - Last Name:BOWE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:CRT, LMT
Mailing Address - Street 1:4500 N FEDERAL HWY
Mailing Address - Street 2:#270
Mailing Address - City:LIGHTHOUSE POINT
Mailing Address - State:FL
Mailing Address - Zip Code:33064-6571
Mailing Address - Country:US
Mailing Address - Phone:561-245-5231
Mailing Address - Fax:
Practice Address - Street 1:2701 NE 42ND ST
Practice Address - Street 2:
Practice Address - City:LIGHTHOUSE POINT
Practice Address - State:FL
Practice Address - Zip Code:33064-8476
Practice Address - Country:US
Practice Address - Phone:561-245-5231
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-02
Last Update Date:2013-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
174H00000X
FLMA36525225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
No174H00000XOther Service ProvidersHealth Educator