Provider Demographics
NPI:1972868123
Name:BOWMAN, TASHA MICHELLE (ATC)
Entity Type:Individual
Prefix:
First Name:TASHA
Middle Name:MICHELLE
Last Name:BOWMAN
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:82 BAXTER ST
Mailing Address - Street 2:
Mailing Address - City:WILLISTON
Mailing Address - State:SC
Mailing Address - Zip Code:29853-2008
Mailing Address - Country:US
Mailing Address - Phone:803-627-7181
Mailing Address - Fax:
Practice Address - Street 1:82 BAXTER ST
Practice Address - Street 2:
Practice Address - City:WILLISTON
Practice Address - State:SC
Practice Address - Zip Code:29853-2008
Practice Address - Country:US
Practice Address - Phone:803-627-7181
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-07-12
Last Update Date:2012-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC12072255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer