Provider Demographics
NPI:1336756535
Name:HILL, ROWAN JAI (LMT)
Entity Type:Individual
Prefix:
First Name:ROWAN
Middle Name:JAI
Last Name:HILL
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8219 RIVER COUNTRY DR
Mailing Address - Street 2:
Mailing Address - City:WEEKI WACHEE
Mailing Address - State:FL
Mailing Address - Zip Code:34607-2137
Mailing Address - Country:US
Mailing Address - Phone:352-587-7807
Mailing Address - Fax:
Practice Address - Street 1:8219 RIVER COUNTRY DR
Practice Address - Street 2:
Practice Address - City:WEEKI WACHEE
Practice Address - State:FL
Practice Address - Zip Code:34607-2137
Practice Address - Country:US
Practice Address - Phone:352-835-7410
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-30
Last Update Date:2020-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA42306225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLMA42306OtherSTATE OF FLORIDA DEPT OF HEALTH DIVISION OF MEDICAL QUALITY ASSURANCE