Provider Demographics
NPI:1497056915
Name:OWENS, DENA SHAE (PTA)
Entity Type:Individual
Prefix:
First Name:DENA
Middle Name:SHAE
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 1:6100 OLD BRANDON RD
Mailing Address - Street 2:
Mailing Address - City:BRANDON
Mailing Address - State:MS
Mailing Address - Zip Code:39042-2543
Mailing Address - Country:US
Mailing Address - Phone:601-260-4605
Mailing Address - Fax:601-933-1113
Practice Address - Street 1:6100 OLD BRANDON RD
Practice Address - Street 2:
Practice Address - City:BRANDON
Practice Address - State:MS
Practice Address - Zip Code:39042-2543
Practice Address - Country:US
Practice Address - Phone:601-260-4605
Practice Address - Fax:601-933-1113
Is Sole Proprietor?:No
Enumeration Date:2010-11-15
Last Update Date:2011-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSPTA 2698225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant