Basic Information
| Provider Information | |||||||||
| NPI: | 1679602551 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ROWLAND | ||||||||
| FirstName: | TODD | ||||||||
| MiddleName: | RICHARD | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 1209 | ||||||||
| Address2: | |||||||||
| City: | MURRELLS INLET | ||||||||
| State: | SC | ||||||||
| PostalCode: | 295761209 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8436528220 | ||||||||
| FaxNumber: | 8435208365 | ||||||||
| Practice Location | |||||||||
| Address1: | 4040 HIGHWAY 17 | ||||||||
| Address2: | SUITE 101 | ||||||||
| City: | MURRELLS INLET | ||||||||
| State: | SC | ||||||||
| PostalCode: | 295765098 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8436528160 | ||||||||
| FaxNumber: | 8436528161 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/05/2007 | ||||||||
| LastUpdateDate: | 11/10/2016 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208100000X | 38896 | SC | Y | Allopathic & Osteopathic Physicians | Physical Medicine & Rehabilitation |
ID Information
| ID | Type | State | Issuer | Description | 38896 | 01 | SC | STATE MEDICAL LICENSE | OTHER | BR3440637 | 01 | IN | DEA | OTHER | 01049168 | 01 | IN | INDIANA LICENSE | OTHER |