Provider Demographics
NPI:1629220835
Name:OWENS PHYSICAL THERAPY SPECIALISTS, LLC
Entity Type:Organization
Organization Name:OWENS PHYSICAL THERAPY SPECIALISTS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER/OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:
Authorized Official - Last Name:OWENS
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:616-956-0400
Mailing Address - Street 1:2849 MICHIGAN ST NE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49506-1216
Mailing Address - Country:US
Mailing Address - Phone:616-956-0400
Mailing Address - Fax:616-956-0404
Practice Address - Street 1:2849 MICHIGAN ST NE
Practice Address - Street 2:SUITE 100
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49506-1216
Practice Address - Country:US
Practice Address - Phone:616-956-0400
Practice Address - Fax:616-956-0404
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-21
Last Update Date:2008-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501010836225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIMI1066Medicare PIN