Provider Demographics
NPI:1376144139
Name:OWSOWITZ, LAUREN (DPT)
Entity Type:Individual
Prefix:
First Name:LAUREN
Middle Name:
Last Name:OWSOWITZ
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 1:1155 MALABAR RD NE STE 1
Mailing Address - Street 2:
Mailing Address - City:PALM BAY
Mailing Address - State:FL
Mailing Address - Zip Code:32907-3262
Mailing Address - Country:US
Mailing Address - Phone:321-409-5777
Mailing Address - Fax:
Practice Address - Street 1:4127 MEANDER PL UNIT 104
Practice Address - Street 2:
Practice Address - City:ROCKLEDGE
Practice Address - State:FL
Practice Address - Zip Code:32955-5297
Practice Address - Country:US
Practice Address - Phone:603-496-7947
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-06
Last Update Date:2020-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist