Provider Demographics
NPI:1336715937
Name:BOWEN, STORM (LAT, ATC)
Entity Type:Individual
Prefix:
First Name:STORM
Middle Name:
Last Name:BOWEN
Suffix:
Gender:F
Credentials:LAT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:736 CL TART CIR APT 301
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28314-3144
Mailing Address - Country:US
Mailing Address - Phone:207-930-0358
Mailing Address - Fax:
Practice Address - Street 1:407TH SSA TAYLOR STREET BLDG A2530
Practice Address - Street 2:
Practice Address - City:FORT BRAGG
Practice Address - State:NC
Practice Address - Zip Code:28310-0001
Practice Address - Country:US
Practice Address - Phone:207-930-0358
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-03
Last Update Date:2021-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PART0068822255A2300X
MEAT7972255A2300X
NCLAT-39732255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic TrainerGroup - Single Specialty