Provider Demographics
NPI:1316021496
Name:OWENS, JEREMY LAYNE (PHYSICAL THERAPIST)
Entity Type:Individual
Prefix:MR
First Name:JEREMY
Middle Name:LAYNE
Last Name:OWENS
Suffix:
Gender:M
Credentials:PHYSICAL THERAPIST
Other - Prefix:
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Mailing Address - Street 1:PO BOX 130189
Mailing Address - Street 2:
Mailing Address - City:TYLER
Mailing Address - State:TX
Mailing Address - Zip Code:75713-0189
Mailing Address - Country:US
Mailing Address - Phone:903-939-7552
Mailing Address - Fax:903-531-0192
Practice Address - Street 1:3414 GOLDEN ROAD
Practice Address - Street 2:
Practice Address - City:TYLER
Practice Address - State:TX
Practice Address - Zip Code:75701-8336
Practice Address - Country:US
Practice Address - Phone:903-939-7552
Practice Address - Fax:903-531-0192
Is Sole Proprietor?:No
Enumeration Date:2006-10-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1151201225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist