Provider Demographics
NPI:1902573025
Name:BOWEN, DAVID W (DPT)
Entity Type:Individual
Prefix:MR
First Name:DAVID
Middle Name:W
Last Name:BOWEN
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:653 SUMMER ST FL 2
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02210-2108
Mailing Address - Country:US
Mailing Address - Phone:617-269-6262
Mailing Address - Fax:617-269-1068
Practice Address - Street 1:653 SUMMER ST FL 2
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02210-2108
Practice Address - Country:US
Practice Address - Phone:617-269-6262
Practice Address - Fax:617-269-1068
Is Sole Proprietor?:No
Enumeration Date:2021-08-26
Last Update Date:2021-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA256892081S0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2081S0010XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationSports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA110088221AMedicaid