Provider Demographics
NPI:1528739240
Name:ROWLAND, KIMBERLY
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:
Last Name:ROWLAND
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:976 VANHOOSER RD
Mailing Address - Street 2:
Mailing Address - City:GRAND RIVERS
Mailing Address - State:KY
Mailing Address - Zip Code:42045-9162
Mailing Address - Country:US
Mailing Address - Phone:270-562-0422
Mailing Address - Fax:
Practice Address - Street 1:976 VANHOOSER RD
Practice Address - Street 2:
Practice Address - City:GRAND RIVERS
Practice Address - State:KY
Practice Address - Zip Code:42045-9162
Practice Address - Country:US
Practice Address - Phone:270-562-0422
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-22
Last Update Date:2021-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYA012718225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant