Provider Demographics
NPI:1053058768
Name:OWCZARZAK, COLTON (PT, DPT)
Entity Type:Individual
Prefix:DR
First Name:COLTON
Middle Name:
Last Name:OWCZARZAK
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5132 DOUGHTYMEWS LN
Mailing Address - Street 2:
Mailing Address - City:FUQUAY VARINA
Mailing Address - State:NC
Mailing Address - Zip Code:27526-7672
Mailing Address - Country:US
Mailing Address - Phone:831-524-2966
Mailing Address - Fax:
Practice Address - Street 1:5132 DOUGHTYMEWS LN
Practice Address - Street 2:
Practice Address - City:FUQUAY VARINA
Practice Address - State:NC
Practice Address - Zip Code:27526
Practice Address - Country:US
Practice Address - Phone:831-524-2966
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-14
Last Update Date:2024-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP21243225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist