Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | 3915 | NM |
NPI | 1003204165 |
---|---|
Provider Name | Jennifer Bowman-Campbell |
First Address | Clovis, NM 88101-6371 |
Second Address | Clovis, NM 88101-6371 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/12/2014 |
Last Update Date | 17/02/2015 |