Healthcare Provider Details

I. General information

NPI: 1114929692
Provider Name (Legal Business Name): GEORGE TOWERS ROWLAND III PT, OCS, CERT.MDT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/13/2005
Last Update Date: 04/24/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

121 LEES LN
HADDON TOWNSHIP NJ
08107-1030
US

IV. Provider business mailing address

121 LEES LN
HADDON TOWNSHIP NJ
08107-1030
US

V. Phone/Fax

Practice location:
  • Phone: 856-858-8222
  • Fax: 856-858-8222
Mailing address:
  • Phone: 856-858-8222
  • Fax: 856-858-8222

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number40QA00248000
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: