Provider Demographics
NPI:1538389689
Name:BOWERSOX, KENNETH FRANKLIN JR (LMT)
Entity type:Individual
Prefix:MR
First Name:KENNETH
Middle Name:FRANKLIN
Last Name:BOWERSOX
Suffix:JR
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2445 LOCUST ST S
Mailing Address - Street 2:
Mailing Address - City:CANAL FULTON
Mailing Address - State:OH
Mailing Address - Zip Code:44614-9391
Mailing Address - Country:US
Mailing Address - Phone:330-687-4874
Mailing Address - Fax:330-854-6571
Practice Address - Street 1:2445 LOCUST ST S
Practice Address - Street 2:
Practice Address - City:CANAL FULTON
Practice Address - State:OH
Practice Address - Zip Code:44614-9391
Practice Address - Country:US
Practice Address - Phone:330-687-4874
Practice Address - Fax:330-854-6571
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-30
Last Update Date:2014-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH9964225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist