Individual
KOURTNEY LANE BOWYER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
ATC
Contact information
Practice address
11200 GOVERNOR MANLY WAY, SUITE 309, RALEIGH, NC 27614-8599
(919) 562-9410
Mailing address
20446 KODIAC RD, GOODMAN, MO 64843-9147
(417) 455-3133
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
2258
NC
Other
Enumeration date
09/05/2013
Last updated
09/05/2013
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