Provider Demographics
NPI:1316446206
Name:ROWAN, MARK L
Entity type:Individual
Prefix:
First Name:MARK
Middle Name:L
Last Name:ROWAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:MARK
Other - Middle Name:L
Other - Last Name:ROWAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DPT
Mailing Address - Street 1:667 NORTH RIVER STREET
Mailing Address - Street 2:
Mailing Address - City:PLAINS
Mailing Address - State:PA
Mailing Address - Zip Code:18705
Mailing Address - Country:US
Mailing Address - Phone:570-825-7676
Mailing Address - Fax:570-825-3424
Practice Address - Street 1:667 NORTH RIVER STREET
Practice Address - Street 2:
Practice Address - City:PLAINS
Practice Address - State:PA
Practice Address - Zip Code:18705
Practice Address - Country:US
Practice Address - Phone:570-825-7676
Practice Address - Fax:570-825-3424
Is Sole Proprietor?:Yes
Enumeration Date:2018-02-06
Last Update Date:2018-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT008171L225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist