Provider Demographics
NPI:1871996108
Name:BOWE, SOPHIA (ATC)
Entity type:Individual
Prefix:
First Name:SOPHIA
Middle Name:
Last Name:BOWE
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:406 SUMMIT AVE E
Mailing Address - Street 2:APT A
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98102-4827
Mailing Address - Country:US
Mailing Address - Phone:360-316-9177
Mailing Address - Fax:
Practice Address - Street 1:406 SUMMIT AVE E
Practice Address - Street 2:APT A
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98102-4827
Practice Address - Country:US
Practice Address - Phone:360-316-9177
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-01
Last Update Date:2014-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAA1 603928242255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2000014182OtherBOC