Provider Demographics
NPI:1235957556
Name:BOWMAN, CONNER STUART (PT, DPT)
Entity type:Individual
Prefix:
First Name:CONNER
Middle Name:STUART
Last Name:BOWMAN
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:417 MOUNT VERNON AVE
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:VA
Mailing Address - Zip Code:24153-3707
Mailing Address - Country:US
Mailing Address - Phone:804-399-2254
Mailing Address - Fax:
Practice Address - Street 1:3433 SPRINGTREE DR NE
Practice Address - Street 2:
Practice Address - City:ROANOKE
Practice Address - State:VA
Practice Address - Zip Code:24012-6443
Practice Address - Country:US
Practice Address - Phone:540-981-2790
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-26
Last Update Date:2024-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305216445225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist