Active NPI
Virginia K Bowen, P.T.
- Physical Therapist
- Random Lake, WI
National Provider Identifier
1790916443
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 3453024
- Practice address
- 402 First Street
Random Lake, WI 53075 - Phone
- (920) 994-9700
- Fax
- (920) 994-4606
- NPI assigned
- Jul 29, 2009
- Last updated
- Sep 29, 2009
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | 3453024 | WI | Primary |
Addresses
Primary practice location
402 First Street
Random Lake, WI 53075
Mailing address
5242 Millshire Rd
Greendale, WI 53129-1242
Phone (414) 421-8014
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 3453024 | WI | MD | Physical Therapist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Mueller Therapy, Inc. | Physical Therapist | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1248825600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1254182400000",
"number": "1790916443",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5242 MILLSHIRE RD",
"city": "GREENDALE",
"state": "WI",
"postal_code": "531291242",
"telephone_number": "414-421-8014"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "402 FIRST STREET",
"city": "RANDOM LAKE",
"state": "WI",
"postal_code": "53075",
"telephone_number": "920-994-9700",
"fax_number": "920-994-4606"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BOWEN",
"first_name": "VIRGINIA",
"middle_name": "K",
"name_prefix": "Ms.",
"credential": "P.T.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2009-07-29",
"last_updated": "2009-09-29",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "WI",
"license": "3453024",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Random Lake, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 29, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.