Provider Demographics
NPI:1649747882
Name:OWENS, TANIKA L (MS, NSCA-CPT)
Entity Type:Individual
Prefix:MS
First Name:TANIKA
Middle Name:L
Last Name:OWENS
Suffix:
Gender:F
Credentials:MS, NSCA-CPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1022 DUMESNIL ST.
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40210-1517
Mailing Address - Country:US
Mailing Address - Phone:502-931-3834
Mailing Address - Fax:502-637-5911
Practice Address - Street 1:1022 DUMESNIL ST.
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40210-1517
Practice Address - Country:US
Practice Address - Phone:502-931-3834
Practice Address - Fax:502-637-5911
Is Sole Proprietor?:No
Enumeration Date:2018-10-25
Last Update Date:2018-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY039048226300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes226300000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersKinesiotherapist