Provider Demographics
NPI:1629010889
Name:OWENS, CHARLES KEVIN (PT)
Entity Type:Individual
Prefix:MR
First Name:CHARLES
Middle Name:KEVIN
Last Name:OWENS
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:10504 FIRVIEW CT
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40299-5843
Mailing Address - Country:US
Mailing Address - Phone:502-741-6897
Mailing Address - Fax:
Practice Address - Street 1:115 HUSTON DR
Practice Address - Street 2:SUITE 3
Practice Address - City:SHEPHERDSVILLE
Practice Address - State:KY
Practice Address - Zip Code:40165-7250
Practice Address - Country:US
Practice Address - Phone:502-921-0272
Practice Address - Fax:502-921-0465
Is Sole Proprietor?:No
Enumeration Date:2006-06-12
Last Update Date:2011-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY004421225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist