Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225700000X | Massage Therapist | MA40334 | FL |
NPI | 1013157700 |
---|---|
Provider Name | Mr. Craig David Bowlen |
First Address | Panama City, FL 32401-1246 |
Second Address | Panama City, FL 32401-1246 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 20/02/2009 |
Last Update Date | 20/02/2009 |