Provider Demographics
NPI:1750020806
Name:ROWE, WILLIAM JULIUS JR
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:JULIUS
Last Name:ROWE
Suffix:JR
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 1:4140 STRATFORD WAY
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32225-3659
Mailing Address - Country:US
Mailing Address - Phone:904-416-9554
Mailing Address - Fax:
Practice Address - Street 1:4140 STRATFORD WAY
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32225-3659
Practice Address - Country:US
Practice Address - Phone:904-416-9554
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-27
Last Update Date:2022-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL251C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services