Provider Demographics
NPI:1457889669
Name:BOWEN, JEREMY (ATC)
Entity type:Individual
Prefix:
First Name:JEREMY
Middle Name:
Last Name:BOWEN
Suffix:
Gender:M
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5200 N LAKE RD
Mailing Address - Street 2:
Mailing Address - City:MERCED
Mailing Address - State:CA
Mailing Address - Zip Code:95343-5001
Mailing Address - Country:US
Mailing Address - Phone:916-770-6149
Mailing Address - Fax:
Practice Address - Street 1:5200 N LAKE RD
Practice Address - Street 2:
Practice Address - City:MERCED
Practice Address - State:CA
Practice Address - Zip Code:95343-5001
Practice Address - Country:US
Practice Address - Phone:209-228-2468
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-01
Last Update Date:2019-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer