Provider Demographics
NPI:1295799344
Name:BADENHORST, ROWENA (RPT)
Entity type:Individual
Prefix:
First Name:ROWENA
Middle Name:
Last Name:BADENHORST
Suffix:
Gender:F
Credentials:RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4517 PEBBLE BEACH DR
Mailing Address - Street 2:
Mailing Address - City:SEBRING
Mailing Address - State:FL
Mailing Address - Zip Code:33872-1731
Mailing Address - Country:US
Mailing Address - Phone:863-453-3701
Mailing Address - Fax:
Practice Address - Street 1:1221 W STRATFORD RD
Practice Address - Street 2:
Practice Address - City:AVON PARK
Practice Address - State:FL
Practice Address - Zip Code:33825-8091
Practice Address - Country:US
Practice Address - Phone:863-453-3701
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-14
Last Update Date:2008-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT0010746208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLY6810OtherBLUE CROSS BLUE SHIELD
FLY6810OtherBLUE CROSS BLUE SHIELD