Healthcare Provider Details

I. General information

NPI: 1821034489
Provider Name (Legal Business Name): DAVID ELLIOTT ROWLEY CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/21/2006
Last Update Date: 09/19/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1110 W KETTLEMAN LN SUITE 13
LODI CA
95240-6031
US

IV. Provider business mailing address

1110 W KETTLEMAN LN SUITE 13
LODI CA
95240-6031
US

V. Phone/Fax

Practice location:
  • Phone: 209-333-1696
  • Fax:
Mailing address:
  • Phone: 209-333-1696
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License NumberPT9906
License Number StateCA

VIII. Authorized Official

Name: MR. DAVID E ROWLEY
Title or Position: MANAGER
Credential: P.T.
Phone: 209-333-1696