Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251P0200X | Physical Therapist - Pediatrics | 293010 | CA |
NPI | 1134665664 |
---|---|
Provider Name | Jeremy Bowlin |
First Address | Lynwood, CA 90262-3533 |
Second Address | Alhambra, CA 91803-8849 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/01/2017 |
Last Update Date | 16/04/2018 |