Provider Demographics
NPI:1003446584
Name:OWSLEY, BRENDAN SCOTT (PTA)
Entity Type:Individual
Prefix:MR
First Name:BRENDAN
Middle Name:SCOTT
Last Name:OWSLEY
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1930 N BUSINESS ROUTE 5 UNIT 1B
Mailing Address - Street 2:
Mailing Address - City:CAMDENTON
Mailing Address - State:MO
Mailing Address - Zip Code:65020-2659
Mailing Address - Country:US
Mailing Address - Phone:573-346-7445
Mailing Address - Fax:
Practice Address - Street 1:1930 N BUSINESS ROUTE 5 UNIT 1B
Practice Address - Street 2:
Practice Address - City:CAMDENTON
Practice Address - State:MO
Practice Address - Zip Code:65020-2659
Practice Address - Country:US
Practice Address - Phone:573-346-7445
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-23
Last Update Date:2020-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2019039394225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant