Provider Demographics
NPI:1841960234
Name:BOWLING, CARLEAH (LMT, CPHT)
Entity type:Individual
Prefix:
First Name:CARLEAH
Middle Name:
Last Name:BOWLING
Suffix:
Gender:F
Credentials:LMT, CPHT
Other - Prefix:
Other - First Name:JONATHAN
Other - Middle Name:
Other - Last Name:BOWLING
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:9616 9TH AVE
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21234-1843
Mailing Address - Country:US
Mailing Address - Phone:410-236-6487
Mailing Address - Fax:
Practice Address - Street 1:100 OWINGS CT STE 12
Practice Address - Street 2:
Practice Address - City:REISTERSTOWN
Practice Address - State:MD
Practice Address - Zip Code:21136-6434
Practice Address - Country:US
Practice Address - Phone:443-814-9788
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-16
Last Update Date:2021-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDM06223225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty