Provider Demographics
NPI:1811987068
Name:BOWEN, FRED EUGENE JR (PT)
Entity type:Individual
Prefix:
First Name:FRED
Middle Name:EUGENE
Last Name:BOWEN
Suffix:JR
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:FRED
Other - Middle Name:EUGENE
Other - Last Name:BOWEN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PT
Mailing Address - Street 1:2840 OAK HAVEN PL
Mailing Address - Street 2:
Mailing Address - City:COOKEVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:38506-6172
Mailing Address - Country:US
Mailing Address - Phone:931-510-6326
Mailing Address - Fax:
Practice Address - Street 1:2840 OAK HAVEN PL
Practice Address - Street 2:
Practice Address - City:COOKEVILLE
Practice Address - State:TN
Practice Address - Zip Code:38506-6172
Practice Address - Country:US
Practice Address - Phone:931-510-6326
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-10-27
Last Update Date:2013-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNPT0000000512225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN0092237OtherBLUE CROSS BLUE SHIELD
TN3650397Medicare PIN