=====================================================
General NPI Number Information
=====================================================
NPI Number | 1467738591
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MYLES W ROWAN PT, DPT
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/03/2011
-----------------------------------------------------
Last Update Date | 01/11/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 6255 SHERIDAN DR STE 100
-----------------------------------------------------
City | WILLIAMSVILLE
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 14221-4825
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 716-320-0237
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 6255 SHERIDAN DR STE 100
-----------------------------------------------------
City | WILLIAMSVILLE
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 14221-4825
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 716-689-6278
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QP2000X
-----------------------------------------------------
Taxonomy Name | Physical Therapy Clinic/Center
-----------------------------------------------------
License Number | 033023-1
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------