Provider Demographics
NPI:1851545545
Name:ROWBACK, DENICE ANN (SRPT, DPT)
Entity Type:Individual
Prefix:MRS
First Name:DENICE
Middle Name:ANN
Last Name:ROWBACK
Suffix:
Gender:F
Credentials:SRPT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14 WADAS DR
Mailing Address - Street 2:
Mailing Address - City:NEW YORK MILLS
Mailing Address - State:NY
Mailing Address - Zip Code:13417-1241
Mailing Address - Country:US
Mailing Address - Phone:315-768-7331
Mailing Address - Fax:
Practice Address - Street 1:14 WADAS DR
Practice Address - Street 2:
Practice Address - City:NEW YORK MILLS
Practice Address - State:NY
Practice Address - Zip Code:13417-1241
Practice Address - Country:US
Practice Address - Phone:315-768-7331
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-09
Last Update Date:2008-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY004181-12251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY004181-1OtherLICENSE NUMBER