Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2081S0010X | Sports Medicine | AL4834 | FL |
Y | 213ES0000X | Sports Medicine | AL4834 | FL |
NPI | 1053924100 |
---|---|
Provider Name | John Thomas Rowell |
First Address | Fort Myers, FL 33965-6565 |
Second Address | Fort Myers, FL 33965-6565 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 28/08/2020 |
Last Update Date | 28/08/2020 |