Provider Demographics
NPI:1013157700
Name:BOWLEN, CRAIG DAVID (LMT)
Entity Type:Individual
Prefix:MR
First Name:CRAIG
Middle Name:DAVID
Last Name:BOWLEN
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1704 MOLITOR AVE
Mailing Address - Street 2:
Mailing Address - City:PANAMA CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32401-1246
Mailing Address - Country:US
Mailing Address - Phone:850-774-7813
Mailing Address - Fax:
Practice Address - Street 1:1704 MOLITOR AVE
Practice Address - Street 2:
Practice Address - City:PANAMA CITY
Practice Address - State:FL
Practice Address - Zip Code:32401-1246
Practice Address - Country:US
Practice Address - Phone:850-774-7813
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-20
Last Update Date:2009-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA40334225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist