Provider Demographics
NPI:1417436908
Name:ROWLEY, KEVIN BARRETT
Entity Type:Individual
Prefix:
First Name:KEVIN
Middle Name:BARRETT
Last Name:ROWLEY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:774 LITTLE JOHN CT
Mailing Address - Street 2:
Mailing Address - City:MACON
Mailing Address - State:GA
Mailing Address - Zip Code:31220-2725
Mailing Address - Country:US
Mailing Address - Phone:478-918-5933
Mailing Address - Fax:
Practice Address - Street 1:2484 INGLESIDE AVE STE B201
Practice Address - Street 2:
Practice Address - City:MACON
Practice Address - State:GA
Practice Address - Zip Code:31204-6515
Practice Address - Country:US
Practice Address - Phone:478-918-5933
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-07
Last Update Date:2018-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAMT0001884225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist