Provider Demographics
NPI:1053642637
Name:OWENS, KAREN SUE (PTA)
Entity Type:Individual
Prefix:MS
First Name:KAREN
Middle Name:SUE
Last Name:OWENS
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2368 S DOUBLE OR NOTHING RD
Mailing Address - Street 2:
Mailing Address - City:SCOTTSBURG
Mailing Address - State:IN
Mailing Address - Zip Code:47170-6613
Mailing Address - Country:US
Mailing Address - Phone:812-752-5163
Mailing Address - Fax:
Practice Address - Street 1:545 W MOONGLO RD
Practice Address - Street 2:
Practice Address - City:SCOTTSBURG
Practice Address - State:IN
Practice Address - Zip Code:47170-7710
Practice Address - Country:US
Practice Address - Phone:812-752-3499
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-01-21
Last Update Date:2010-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN06001448A225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant