Provider Demographics
NPI:1043415581
Name:SPAFFORD, ROWENA MARJORIE (PT)
Entity Type:Individual
Prefix:MRS
First Name:ROWENA
Middle Name:MARJORIE
Last Name:SPAFFORD
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3353 CELINA AVE
Mailing Address - Street 2:
Mailing Address - City:SAINT JOSEPH
Mailing Address - State:MI
Mailing Address - Zip Code:49085-3734
Mailing Address - Country:US
Mailing Address - Phone:269-556-9596
Mailing Address - Fax:
Practice Address - Street 1:2654 W JOHN BEERS RD
Practice Address - Street 2:
Practice Address - City:STEVENSVILLE
Practice Address - State:MI
Practice Address - Zip Code:49127-1213
Practice Address - Country:US
Practice Address - Phone:269-428-1440
Practice Address - Fax:269-428-3992
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501004618225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist