Provider Demographics
NPI:1174129456
Name:BOWMAN, MARCUS R (LMT)
Entity type:Individual
Prefix:
First Name:MARCUS
Middle Name:R
Last Name:BOWMAN
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6055 HILBURN RD
Mailing Address - Street 2:
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32504-6368
Mailing Address - Country:US
Mailing Address - Phone:850-322-3512
Mailing Address - Fax:
Practice Address - Street 1:6400 N DAVIS HWY STE 2
Practice Address - Street 2:
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32504-6968
Practice Address - Country:US
Practice Address - Phone:850-549-3300
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-10
Last Update Date:2020-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA88786225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist