Provider Demographics
NPI:1609948090
Name:OWEN, MONTY (PT)
Entity Type:Individual
Prefix:MR
First Name:MONTY
Middle Name:
Last Name:OWEN
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 1:1823 S ESSEX CIR
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85209-4015
Mailing Address - Country:US
Mailing Address - Phone:480-415-0744
Mailing Address - Fax:480-854-9834
Practice Address - Street 1:4323 E BROADWAY RD
Practice Address - Street 2:SUITE 106
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85206-3506
Practice Address - Country:US
Practice Address - Phone:480-854-9833
Practice Address - Fax:480-854-9834
Is Sole Proprietor?:No
Enumeration Date:2006-11-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ2989225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZAZ0297810OtherBCBS
AZP93773Medicare UPIN
AZZ68504Medicare ID - Type UnspecifiedMEDICARE NUMBER