Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | PT-5866 | ID |
NPI | 1003300971 |
---|---|
Provider Name | Peter James Rowley |
First Address | Meridian, ID 83646-1839 |
Second Address | Nampa, ID 83686-2856 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/06/2018 |
Last Update Date | 14/06/2018 |