Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | 03649 | LA |
NPI | 1003036005 |
---|---|
Provider Name | Mrs. Alyce Cresson Bowers |
First Address | Metairie, LA 70001-2625 |
Second Address | Denham Springs, LA 70726-7865 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/05/2007 |
Last Update Date | 08/07/2007 |