Provider Demographics
NPI:1013265347
Name:BOWN, KYLE (DPT)
Entity type:Individual
Prefix:
First Name:KYLE
Middle Name:
Last Name:BOWN
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6101 S 56 #1
Mailing Address - Street 2:CROSSROADS PHYSICAL THERAPY, PC
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68516
Mailing Address - Country:US
Mailing Address - Phone:402-420-0800
Mailing Address - Fax:402-420-0801
Practice Address - Street 1:6101 S 56 #1
Practice Address - Street 2:CROSSROADS PHYSICAL THERAPY, PC
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68516
Practice Address - Country:US
Practice Address - Phone:402-420-0800
Practice Address - Fax:402-420-0801
Is Sole Proprietor?:No
Enumeration Date:2012-08-16
Last Update Date:2012-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE3135225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist