Provider Demographics
NPI:1376373696
Name:BROWNLOW, RODERICK CHARLES (PTA)
Entity type:Individual
Prefix:
First Name:RODERICK
Middle Name:CHARLES
Last Name:BROWNLOW
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:814 E CAMP WISDOM RD
Mailing Address - Street 2:
Mailing Address - City:DUNCANVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:75116-2828
Mailing Address - Country:US
Mailing Address - Phone:214-217-0303
Mailing Address - Fax:
Practice Address - Street 1:814 E CAMP WISDOM RD
Practice Address - Street 2:
Practice Address - City:DUNCANVILLE
Practice Address - State:TX
Practice Address - Zip Code:75116-2828
Practice Address - Country:US
Practice Address - Phone:214-217-0303
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-02
Last Update Date:2024-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2034387225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant