Provider Demographics
NPI:1053382911
Name:ROWEN HERZOG, ROBERT (PT)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:
Last Name:ROWEN HERZOG
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:ROBERT
Other - Middle Name:
Other - Last Name:HERZOG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:8690 PETALUMA HILL RD
Mailing Address - Street 2:
Mailing Address - City:PENNGROVE
Mailing Address - State:CA
Mailing Address - Zip Code:94951-8734
Mailing Address - Country:US
Mailing Address - Phone:707-779-9162
Mailing Address - Fax:
Practice Address - Street 1:8690 PETALUMA HILL RD
Practice Address - Street 2:
Practice Address - City:PENNGROVE
Practice Address - State:CA
Practice Address - Zip Code:94951-8734
Practice Address - Country:US
Practice Address - Phone:707-779-9162
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-30
Last Update Date:2014-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA356982251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics