Doctor Name: | KYLE BOW |
NPI Number: | 1518365717 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | PTA |
License Number: | 2084702 |
Business Practice Address: | 618 Jackson St Rockdale, TX - 765672216 |
Business Phone Number: | 5124291575 |
Business Fax Number: | |
Mailing Address: | 618 Jackson St, ROCKDALE |
State: | TX |
Postal Code: | 765672216 |
Phone Number: | 5124291575 |
Fax Number: | |
NPI Enumeration Date: | 12/21/2014 |
NPI Last Update Date: | 12/21/2014 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 261QP2000X |
License Number: | 2084702 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | TX |
Taxonomy Type: | Ambulatory Health Care Facilities |
Taxonomy Classification: | Clinic/Center |
Taxonomy Specialization: | Physical Therapy |
Taxonomy Definition: |