Provider Demographics
NPI:1902432685
Name:ROWE, THERESE (PA)
Entity Type:Individual
Prefix:
First Name:THERESE
Middle Name:
Last Name:ROWE
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:THERESE
Other - Middle Name:
Other - Last Name:VALLEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:507 OLD INDIAN TRL
Mailing Address - Street 2:
Mailing Address - City:DEFOREST
Mailing Address - State:WI
Mailing Address - Zip Code:53532-3078
Mailing Address - Country:US
Mailing Address - Phone:608-692-3966
Mailing Address - Fax:
Practice Address - Street 1:1 POINT PL STE 200
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53719-2836
Practice Address - Country:US
Practice Address - Phone:608-820-2381
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-03-13
Last Update Date:2020-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI4955-232083A0300X, 363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No2083A0300XAllopathic & Osteopathic PhysiciansPreventive MedicineAddiction Medicine