Provider Demographics
NPI:1740613504
Name:BOWES, PATRICE ELIZABETH (LMT)
Entity type:Individual
Prefix:MS
First Name:PATRICE
Middle Name:ELIZABETH
Last Name:BOWES
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1964 SE KORONA DR
Mailing Address - Street 2:
Mailing Address - City:PORT SAINT LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34952-8050
Mailing Address - Country:US
Mailing Address - Phone:772-985-6754
Mailing Address - Fax:
Practice Address - Street 1:1850 43RD AVE STE C10
Practice Address - Street 2:
Practice Address - City:VERO BEACH
Practice Address - State:FL
Practice Address - Zip Code:32960-0501
Practice Address - Country:US
Practice Address - Phone:772-985-6754
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-08-15
Last Update Date:2016-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA73754225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist