Provider Demographics
NPI:1497726723
Name:ROWE, ROBERT A (PT)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:A
Last Name:ROWE
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6 MYSTIC LN
Mailing Address - Street 2:
Mailing Address - City:MANSFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:02048
Mailing Address - Country:US
Mailing Address - Phone:508-339-2743
Mailing Address - Fax:
Practice Address - Street 1:1 PEARL ST
Practice Address - Street 2:STE 1700
Practice Address - City:BROCKTON
Practice Address - State:MA
Practice Address - Zip Code:02301
Practice Address - Country:US
Practice Address - Phone:508-580-1690
Practice Address - Fax:508-580-0964
Is Sole Proprietor?:No
Enumeration Date:2006-01-26
Last Update Date:2010-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA8699225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
Y68283Medicare ID - Type Unspecified