Provider Demographics
NPI:1144098963
Name:OWEN, ERIK CHARLES
Entity type:Individual
Prefix:
First Name:ERIK
Middle Name:CHARLES
Last Name:OWEN
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 1:2550 S MAIN ST APT 6308
Mailing Address - Street 2:
Mailing Address - City:SOUTH SALT LAKE
Mailing Address - State:UT
Mailing Address - Zip Code:84115-3084
Mailing Address - Country:US
Mailing Address - Phone:317-748-5538
Mailing Address - Fax:
Practice Address - Street 1:2550 S MAIN ST APARTMENTS
Practice Address - Street 2:6308
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84115
Practice Address - Country:US
Practice Address - Phone:317-748-5538
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-12-12
Last Update Date:2023-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist