Provider Demographics
NPI:1821233057
Name:BOWEN, SUZANNE M (PTA)
Entity type:Individual
Prefix:MRS
First Name:SUZANNE
Middle Name:M
Last Name:BOWEN
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 EMERY AVE
Mailing Address - Street 2:SUITE 3
Mailing Address - City:RANDOLPH
Mailing Address - State:NJ
Mailing Address - Zip Code:07869-1368
Mailing Address - Country:US
Mailing Address - Phone:973-895-9925
Mailing Address - Fax:973-895-9927
Practice Address - Street 1:2 EMERY AVE
Practice Address - Street 2:SUITE 3
Practice Address - City:RANDOLPH
Practice Address - State:NJ
Practice Address - Zip Code:07869-1368
Practice Address - Country:US
Practice Address - Phone:973-895-9925
Practice Address - Fax:973-895-9927
Is Sole Proprietor?:No
Enumeration Date:2008-12-02
Last Update Date:2008-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QB02003000225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant