Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251P0200X | Physical Therapist - Pediatrics | 1132330 | TX |
NPI | 1053424614 |
---|---|
Provider Name | Mrs. Celia J Bower |
First Address | Longview, TX 75605-2137 |
Second Address | Longview, TX 75605-2137 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/08/2006 |
Last Update Date | 19/07/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
8T4394 | BC/BS PROVIDER NUMBER (01) | TX |