Provider Demographics
NPI:1538459565
Name:OWENS, JESSICA CHRISTINE (LMT NMT)
Entity Type:Individual
Prefix:MS
First Name:JESSICA
Middle Name:CHRISTINE
Last Name:OWENS
Suffix:
Gender:F
Credentials:LMT NMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:710 N LEMON AVE UNIT 417
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34236-4300
Mailing Address - Country:US
Mailing Address - Phone:941-544-9548
Mailing Address - Fax:
Practice Address - Street 1:630 S ORANGE AVE STE 301E
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34236-7504
Practice Address - Country:US
Practice Address - Phone:941-544-9548
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-11
Last Update Date:2021-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA62679225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist