Provider Demographics
NPI:1710028477
Name:ROWLAND, GONDEE (LMT)
Entity Type:Individual
Prefix:
First Name:GONDEE
Middle Name:
Last Name:ROWLAND
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1100 SAWGRASS VILLAGE DR
Mailing Address - Street 2:SUITE 201C
Mailing Address - City:PONTE VEDRA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32082-5048
Mailing Address - Country:US
Mailing Address - Phone:904-686-4002
Mailing Address - Fax:904-273-6402
Practice Address - Street 1:1100 SAWGRASS VILLAGE DR
Practice Address - Street 2:SUITE 201C
Practice Address - City:PONTE VEDRA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32082-5048
Practice Address - Country:US
Practice Address - Phone:904-686-4002
Practice Address - Fax:904-273-6402
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA16269 MM13177225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLC1468OtherBLUE CROSS BLUE SHIELD
FLFP2797OtherHEALTH NET
FL0007196354OtherAETNA
FL185919351390OtherHUMANA