Basic Information
Provider Information
NPI: 1104226075
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: ROWE
FirstName: NATALIE
MiddleName: C
NamePrefix:  
NameSuffix:  
Credential: DPT
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: PO BOX 1523
Address2:  
City: FAYETTEVILLE
State: AR
PostalCode: 727021523
CountryCode: US
TelephoneNumber: 4795716038
FaxNumber: 4795820222
Practice Location
Address1: 3344 N FUTRALL DR
Address2:  
City: FAYETTEVILLE
State: AR
PostalCode: 727034057
CountryCode: US
TelephoneNumber: 4795827213
FaxNumber: 4795211843
Other Information
ProviderEnumerationDate: 08/28/2014
LastUpdateDate: 08/28/2014
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
225100000XPT3932ARY Respiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist 

No ID Information.


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