Provider Demographics
NPI:1023405214
Name:BOWEN, SANDRICKA MARSHA (PT, DPT, ATC)
Entity type:Individual
Prefix:
First Name:SANDRICKA
Middle Name:MARSHA
Last Name:BOWEN
Suffix:
Gender:F
Credentials:PT, DPT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16068 BOUNDARY DR STE 1
Mailing Address - Street 2:
Mailing Address - City:ASHLAND
Mailing Address - State:MS
Mailing Address - Zip Code:38603-7737
Mailing Address - Country:US
Mailing Address - Phone:662-587-0312
Mailing Address - Fax:
Practice Address - Street 1:16068 BOUNDARY DR STE 1
Practice Address - Street 2:
Practice Address - City:ASHLAND
Practice Address - State:MS
Practice Address - Zip Code:38603-7737
Practice Address - Country:US
Practice Address - Phone:662-534-4445
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-04-25
Last Update Date:2020-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSAT09062255A2300X
MSPT6549225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer