MEDICARE: MRS. DENICE ANN ROWBACK SR.PT, DPT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2251P0200X	Pediatric Physical Therapist	004181-1	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	004181-1	OTHER	NY	LICENSE NUMBER

General Provider Information

NPI Number	:	1851545545
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. DENICE ANN ROWBACK SR.PT, DPT

Provider Business Mailing Address
First Line	:	14 WADAS DR
Second Line	:
City	:	NEW YORK MILLS
State	:	NY
Zip	:	13417-1241
Country	:	US
Telephone Number	:	315-768-7331
Fax Number	:

Provider Business Practice Location Address
First Line	:	14 WADAS DR
Second Line	:
City	:	NEW YORK MILLS
State	:	NY
Zip	:	13417-1241
Country	:	US
Telephone Number	:	315-768-7331
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/09/2008
Last Update Date	:	11/09/2008

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