Provider Demographics
NPI:1770018103
Name:ROWAN WILSON, LINDA (LCMMP)
Entity Type:Individual
Prefix:
First Name:LINDA
Middle Name:
Last Name:ROWAN WILSON
Suffix:
Gender:F
Credentials:LCMMP
Other - Prefix:
Other - First Name:LYN
Other - Middle Name:
Other - Last Name:ROWAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCMMP
Mailing Address - Street 1:628 SURRY ST
Mailing Address - Street 2:
Mailing Address - City:PORTSMOUTH
Mailing Address - State:VA
Mailing Address - Zip Code:23707-1327
Mailing Address - Country:US
Mailing Address - Phone:757-416-8314
Mailing Address - Fax:256-261-2911
Practice Address - Street 1:628 SURRY ST
Practice Address - Street 2:
Practice Address - City:PORTSMOUTH
Practice Address - State:VA
Practice Address - Zip Code:23707-1327
Practice Address - Country:US
Practice Address - Phone:757-416-8314
Practice Address - Fax:256-261-2911
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-24
Last Update Date:2017-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist