Provider Demographics
NPI:1912887514
Name:ROWELL, NATHAN JERRY
Entity type:Individual
Prefix:
First Name:NATHAN
Middle Name:JERRY
Last Name:ROWELL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5719 S EASTON ST
Mailing Address - Street 2:
Mailing Address - City:TAYLORSVILLE
Mailing Address - State:UT
Mailing Address - Zip Code:84129-1944
Mailing Address - Country:US
Mailing Address - Phone:801-518-4764
Mailing Address - Fax:
Practice Address - Street 1:5719 S EASTON ST
Practice Address - Street 2:
Practice Address - City:TAYLORSVILLE
Practice Address - State:UT
Practice Address - Zip Code:84129-1944
Practice Address - Country:US
Practice Address - Phone:801-518-4764
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-09-04
Last Update Date:2025-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT13196576-4701225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist