1235394958 NPI number — WILLIAM H BOWEN DPT

Table of content: WILLIAM H BOWEN DPT (NPI 1235394958)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1235394958 NPI number — WILLIAM H BOWEN DPT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BOWEN
Provider First Name:
WILLIAM
Provider Middle Name:
H
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
DPT
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1235394958
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/24/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
771 PILOT HOUSE DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NEWPORT NEWS
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
23606-1990
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
757-873-2302
Provider Business Mailing Address Fax Number:
757-873-2306

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
10128 W BROAD ST
Provider Second Line Business Practice Location Address:
FORUM BUILDING III, SUITE K
Provider Business Practice Location Address City Name:
GLEN ALLEN
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
23060-6761
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
804-217-9210
Provider Business Practice Location Address Fax Number:
804-217-9213
Provider Enumeration Date:
07/22/2008

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 225100000X , with the licence number:  2305205483 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1235394958 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".
  • Identifier: P00634358 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 192953 . This is a "BCBS PHYSICAL THERAPY" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 9855165 . This is a "AETNA" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".




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