Basic Information
| Provider Information | |||||||||
| NPI: | 1710064118 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BOWDEN | ||||||||
| FirstName: | TESS | ||||||||
| MiddleName: | G | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2063 E OXFORD DR | ||||||||
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| City: | TEMPE | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 852832464 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5202348499 | ||||||||
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| Practice Location | |||||||||
| Address1: | 15410 S MOUNTAIN PKWY | ||||||||
| Address2: | SUITE 112 | ||||||||
| City: | PHOENIX | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 850446691 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4809408299 | ||||||||
| FaxNumber: | 4807040888 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/01/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225200000X | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapy Assistant |
No ID Information.