Provider Demographics
NPI:1578992129
Name:OWENS, TODD MATTHEW (PT)
Entity Type:Individual
Prefix:DR
First Name:TODD
Middle Name:MATTHEW
Last Name:OWENS
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:105 MOORES GROVE RD
Mailing Address - Street 2:
Mailing Address - City:WINTERVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30683-1517
Mailing Address - Country:US
Mailing Address - Phone:706-742-0082
Mailing Address - Fax:706-742-0083
Practice Address - Street 1:105 MOORES GROVE RD
Practice Address - Street 2:
Practice Address - City:WINTERVILLE
Practice Address - State:GA
Practice Address - Zip Code:30683-1517
Practice Address - Country:US
Practice Address - Phone:706-742-0082
Practice Address - Fax:706-742-0083
Is Sole Proprietor?:No
Enumeration Date:2013-11-04
Last Update Date:2013-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist