Provider Demographics
NPI:1205997566
Name:BOWMAN, FREDERICK (PT)
Entity type:Individual
Prefix:MR
First Name:FREDERICK
Middle Name:
Last Name:BOWMAN
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:50 LILAC RD
Mailing Address - Street 2:
Mailing Address - City:WESTHAMPTON BEACH
Mailing Address - State:NY
Mailing Address - Zip Code:11978-2009
Mailing Address - Country:US
Mailing Address - Phone:631-288-4807
Mailing Address - Fax:631-288-0160
Practice Address - Street 1:50 LILAC RD
Practice Address - Street 2:
Practice Address - City:WESTHAMPTON BEACH
Practice Address - State:NY
Practice Address - Zip Code:11978-2009
Practice Address - Country:US
Practice Address - Phone:631-288-4807
Practice Address - Fax:631-288-0160
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY004588225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYQ17T21Medicare ID - Type UnspecifiedPHYSICAL THERAPIST