Provider Demographics
NPI:1548909724
Name:BOWEN, LUCRETIA LYNN (ATC, CSCS)
Entity type:Individual
Prefix:
First Name:LUCRETIA
Middle Name:LYNN
Last Name:BOWEN
Suffix:
Gender:F
Credentials:ATC, CSCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1437 WILLARD ST
Mailing Address - Street 2:
Mailing Address - City:STURGIS
Mailing Address - State:SD
Mailing Address - Zip Code:57785-1851
Mailing Address - Country:US
Mailing Address - Phone:605-490-7749
Mailing Address - Fax:
Practice Address - Street 1:2479 E COLORADO BLVD
Practice Address - Street 2:
Practice Address - City:SPEARFISH
Practice Address - State:SD
Practice Address - Zip Code:57783-3204
Practice Address - Country:US
Practice Address - Phone:605-490-7749
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-03
Last Update Date:2022-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD03242255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer