Provider Demographics
NPI:1740211762
Name:OWEN, TYNNA L (DPT)
Entity Type:Individual
Prefix:
First Name:TYNNA
Middle Name:L
Last Name:OWEN
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:TYNNA
Other - Middle Name:L
Other - Last Name:FORSMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:40 S RIVER RD
Mailing Address - Street 2:UNIT 58
Mailing Address - City:BEDFORD
Mailing Address - State:NH
Mailing Address - Zip Code:03110-6719
Mailing Address - Country:US
Mailing Address - Phone:603-626-4205
Mailing Address - Fax:603-668-9943
Practice Address - Street 1:40 S RIVER RD
Practice Address - Street 2:BEDFORD PLACE UNIT 58
Practice Address - City:BEDFORD
Practice Address - State:NH
Practice Address - Zip Code:03110-6719
Practice Address - Country:US
Practice Address - Phone:603-626-4205
Practice Address - Fax:603-668-9943
Is Sole Proprietor?:No
Enumeration Date:2006-07-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH2905225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH30394250Medicaid