Provider Demographics
NPI:1295712313
Name:BOWYER, KEITH A JR (PT)
Entity type:Individual
Prefix:MR
First Name:KEITH
Middle Name:A
Last Name:BOWYER
Suffix:JR
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 YMCA LN
Mailing Address - Street 2:
Mailing Address - City:SEBRING
Mailing Address - State:FL
Mailing Address - Zip Code:33875-4352
Mailing Address - Country:US
Mailing Address - Phone:863-382-2949
Mailing Address - Fax:863-382-4732
Practice Address - Street 1:100 YMCA LN
Practice Address - Street 2:
Practice Address - City:SEBRING
Practice Address - State:FL
Practice Address - Zip Code:33875-4352
Practice Address - Country:US
Practice Address - Phone:863-382-2949
Practice Address - Fax:863-382-4732
Is Sole Proprietor?:No
Enumeration Date:2005-12-29
Last Update Date:2012-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT16172225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLPT16172OtherFL LICENSE NUMBER