Provider Demographics
NPI:1730246372
Name:MILLIGAN ROWLAND, JACQUE KAY (PT)
Entity type:Individual
Prefix:MRS
First Name:JACQUE
Middle Name:KAY
Last Name:MILLIGAN ROWLAND
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 1:10800 HOLLY AVE NE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87122-3114
Mailing Address - Country:US
Mailing Address - Phone:505-344-2238
Mailing Address - Fax:505-345-2409
Practice Address - Street 1:301 CALLE DEL ESCUELA
Practice Address - Street 2:
Practice Address - City:BERNALILLO
Practice Address - State:NM
Practice Address - Zip Code:87004-6096
Practice Address - Country:US
Practice Address - Phone:505-867-3366
Practice Address - Fax:505-867-7851
Is Sole Proprietor?:No
Enumeration Date:2007-01-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM202225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NMK0118Medicaid