Provider Demographics
NPI:1922292465
Name:BOWMAN, REBECCA L (PT)
Entity type:Individual
Prefix:
First Name:REBECCA
Middle Name:L
Last Name:BOWMAN
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11755 E MICHIGAN AVE
Mailing Address - Street 2:
Mailing Address - City:GRASS LAKE
Mailing Address - State:MI
Mailing Address - Zip Code:49240-9219
Mailing Address - Country:US
Mailing Address - Phone:517-234-3430
Mailing Address - Fax:517-234-3430
Practice Address - Street 1:11755 E MICHIGAN AVE
Practice Address - Street 2:
Practice Address - City:GRASS LAKE
Practice Address - State:MI
Practice Address - Zip Code:49240-9219
Practice Address - Country:US
Practice Address - Phone:517-234-3430
Practice Address - Fax:517-234-3430
Is Sole Proprietor?:No
Enumeration Date:2007-08-28
Last Update Date:2024-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501003957225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist