Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251P0200X | Physical Therapist - Pediatrics | 35698 | CA |
NPI | 1053382911 |
---|---|
Provider Name | Robert Rowen Herzog |
First Address | Penngrove, CA 94951-8734 |
Second Address | Penngrove, CA 94951-8734 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 30/01/2006 |
Last Update Date | 08/01/2014 |