Provider Demographics
NPI:1902072689
Name:ANGOLUAN, ROWENA A (PT)
Entity Type:Individual
Prefix:MRS
First Name:ROWENA
Middle Name:A
Last Name:ANGOLUAN
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1199
Mailing Address - Street 2:
Mailing Address - City:LEHIGH ACRES
Mailing Address - State:FL
Mailing Address - Zip Code:33970-1199
Mailing Address - Country:US
Mailing Address - Phone:239-303-9100
Mailing Address - Fax:239-303-9101
Practice Address - Street 1:1415 HOMESTEAD ROAD N
Practice Address - Street 2:
Practice Address - City:LEHIGH AC RES
Practice Address - State:FL
Practice Address - Zip Code:33936-4830
Practice Address - Country:US
Practice Address - Phone:239-303-9100
Practice Address - Fax:239-303-9101
Is Sole Proprietor?:No
Enumeration Date:2008-05-02
Last Update Date:2008-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT 14658174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist