Provider Demographics
NPI:1891027827
Name:BOWMAN, SALLY (MED,RD/LD)
Entity type:Individual
Prefix:
First Name:SALLY
Middle Name:
Last Name:BOWMAN
Suffix:
Gender:F
Credentials:MED,RD/LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2308 LAKE AUSTIN BLVD
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78703-4546
Mailing Address - Country:US
Mailing Address - Phone:512-469-7676
Mailing Address - Fax:512-236-1774
Practice Address - Street 1:2308 LAKE AUSTIN BLVD
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78703-4546
Practice Address - Country:US
Practice Address - Phone:512-469-7676
Practice Address - Fax:512-236-1774
Is Sole Proprietor?:No
Enumeration Date:2010-02-01
Last Update Date:2010-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX04811133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered