Provider Demographics
NPI:1972847200
Name:DOWDIN, LAWRENCE ANDREW
Entity Type:Individual
Prefix:
First Name:LAWRENCE
Middle Name:ANDREW
Last Name:DOWDIN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:FRODO
Other - Middle Name:
Other - Last Name:DOWDIN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:427 N TRACY AVE
Mailing Address - Street 2:
Mailing Address - City:BOZEMAN
Mailing Address - State:MT
Mailing Address - Zip Code:59715-3528
Mailing Address - Country:US
Mailing Address - Phone:406-586-8832
Mailing Address - Fax:
Practice Address - Street 1:427 N TRACY AVE
Practice Address - Street 2:
Practice Address - City:BOZEMAN
Practice Address - State:MT
Practice Address - Zip Code:59715-3528
Practice Address - Country:US
Practice Address - Phone:406-586-8832
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-27
Last Update Date:2012-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT23225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist