Provider Demographics
NPI:1831509843
Name:BOWERS, BARRY JR
Entity type:Individual
Prefix:
First Name:BARRY
Middle Name:
Last Name:BOWERS
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:790 REMINGTON BLVD
Mailing Address - Street 2:
Mailing Address - City:BOLINGBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60440-4909
Mailing Address - Country:US
Mailing Address - Phone:630-296-2223
Mailing Address - Fax:
Practice Address - Street 1:1306 GEMINI CIR
Practice Address - Street 2:STE 3
Practice Address - City:OTTAWA
Practice Address - State:IL
Practice Address - Zip Code:61350-1694
Practice Address - Country:US
Practice Address - Phone:815-431-9980
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-04-29
Last Update Date:2014-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070020435225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILF400172064Medicare PIN
ILF400134253Medicare PIN
ILF400172074Medicare PIN