Provider Demographics
NPI:1508348996
Name:OWEN, JASMYNE (PT, DPT)
Entity Type:Individual
Prefix:
First Name:JASMYNE
Middle Name:
Last Name:OWEN
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:JASMYNE
Other - Middle Name:
Other - Last Name:THEUS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:848 ADAMS AVE
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38103-2816
Mailing Address - Country:US
Mailing Address - Phone:901-287-4300
Mailing Address - Fax:901-287-4350
Practice Address - Street 1:848 ADAMS AVE
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38103-2816
Practice Address - Country:US
Practice Address - Phone:901-287-4300
Practice Address - Fax:901-287-4350
Is Sole Proprietor?:No
Enumeration Date:2018-08-31
Last Update Date:2020-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
225100000X
TN122182251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics