Provider Demographics
NPI:1568160794
Name:OWENS, EMMA ANNE (PTA)
Entity Type:Individual
Prefix:
First Name:EMMA
Middle Name:ANNE
Last Name:OWENS
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:EMMA
Other - Middle Name:ANNE
Other - Last Name:VERBEKE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1125 N 13TH ST
Mailing Address - Street 2:
Mailing Address - City:SHEBOYGAN
Mailing Address - State:WI
Mailing Address - Zip Code:53081-3281
Mailing Address - Country:US
Mailing Address - Phone:920-803-1617
Mailing Address - Fax:920-803-1622
Practice Address - Street 1:2700 W 9TH AVE STE 10
Practice Address - Street 2:
Practice Address - City:OSHKOSH
Practice Address - State:WI
Practice Address - Zip Code:54904-7863
Practice Address - Country:US
Practice Address - Phone:920-738-2000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-02-16
Last Update Date:2023-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3317225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant