Provider Demographics
NPI:1285630285
Name:OWENS, AMY LEIGH (DPT)
Entity Type:Individual
Prefix:MRS
First Name:AMY
Middle Name:LEIGH
Last Name:OWENS
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 5285
Mailing Address - Street 2:
Mailing Address - City:GRAND ISLAND
Mailing Address - State:NE
Mailing Address - Zip Code:68802-5285
Mailing Address - Country:US
Mailing Address - Phone:308-382-0344
Mailing Address - Fax:308-382-3241
Practice Address - Street 1:1230 ARIES DR
Practice Address - Street 2:STE D
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68512-9614
Practice Address - Country:US
Practice Address - Phone:402-434-5895
Practice Address - Fax:402-434-5899
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-23
Last Update Date:2017-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE2037225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE47081373113Medicaid
P00349745OtherMEDICARE RAILROAD
NE02419OtherBCBS
NE2037OtherLICENSE
280616Medicare ID - Type Unspecified