Provider Demographics
NPI:1841883980
Name:BOWLING, BRUCE EDWARD (LMT, CSCS)
Entity type:Individual
Prefix:
First Name:BRUCE
Middle Name:EDWARD
Last Name:BOWLING
Suffix:
Gender:M
Credentials:LMT, CSCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5145 NW 21ST TER
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32605-5453
Mailing Address - Country:US
Mailing Address - Phone:352-373-1899
Mailing Address - Fax:
Practice Address - Street 1:5145 NW 21ST TER
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32605-5453
Practice Address - Country:US
Practice Address - Phone:352-373-1899
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-19
Last Update Date:2021-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA23991225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist