Provider Demographics
NPI:1144915448
Name:BOWEN, SAMANTHA JANE (DPT)
Entity type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:JANE
Last Name:BOWEN
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1329 VANDERBILT RD
Mailing Address - Street 2:
Mailing Address - City:BEL AIR
Mailing Address - State:MD
Mailing Address - Zip Code:21014-2239
Mailing Address - Country:US
Mailing Address - Phone:443-377-8909
Mailing Address - Fax:
Practice Address - Street 1:7080 DEEPAGE DR
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MD
Practice Address - Zip Code:21045-5348
Practice Address - Country:US
Practice Address - Phone:410-381-7000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-04-11
Last Update Date:2023-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD29436225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist