Provider Demographics
NPI:1528008174
Name:OWENS, THERESA L (RPT)
Entity Type:Individual
Prefix:
First Name:THERESA
Middle Name:L
Last Name:OWENS
Suffix:
Gender:F
Credentials:RPT
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 8940
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89507-8940
Mailing Address - Country:US
Mailing Address - Phone:775-784-1999
Mailing Address - Fax:775-784-1995
Practice Address - Street 1:UNR SPORTSMEDICINE COMPLEX
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89507
Practice Address - Country:US
Practice Address - Phone:775-784-1999
Practice Address - Fax:775-784-1995
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV0960225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NVS94919Medicare UPIN