Provider Demographics
NPI:1982841268
Name:SALLY JOHNSON ROWLEY, PA
Entity Type:Organization
Organization Name:SALLY JOHNSON ROWLEY, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:SALLY
Authorized Official - Middle Name:JOHNSON
Authorized Official - Last Name:ROWLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-964-6635
Mailing Address - Street 1:9150 SW 87TH AVE
Mailing Address - Street 2:SUITE 109
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33176-2319
Mailing Address - Country:US
Mailing Address - Phone:305-596-4663
Mailing Address - Fax:
Practice Address - Street 1:9150 SW 87TH AVE
Practice Address - Street 2:SUITE 109
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33176-2319
Practice Address - Country:US
Practice Address - Phone:305-596-4663
Practice Address - Fax:305-596-6947
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-08
Last Update Date:2009-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY6227103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
54699OtherMEDICARE IDENTIFICATION CODE