Provider Demographics
NPI:1972738391
Name:ROWE, KIM E (LMT)
Entity type:Individual
Prefix:MS
First Name:KIM
Middle Name:E
Last Name:ROWE
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:44 KILLEAN PARK
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:NY
Mailing Address - Zip Code:12205-4036
Mailing Address - Country:US
Mailing Address - Phone:518-464-0007
Mailing Address - Fax:
Practice Address - Street 1:44 KILLEAN PARK
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:NY
Practice Address - Zip Code:12205-4036
Practice Address - Country:US
Practice Address - Phone:518-464-0007
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-29
Last Update Date:2009-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY021079225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist