Provider Demographics
NPI:1750331005
Name:OWENS, RICHARD A JR (PT, MS, OCS)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:A
Last Name:OWENS
Suffix:JR
Gender:M
Credentials:PT, MS, OCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2397
Mailing Address - Street 2:
Mailing Address - City:PAWLEYS ISLAND
Mailing Address - State:SC
Mailing Address - Zip Code:29585-2397
Mailing Address - Country:US
Mailing Address - Phone:843-831-0163
Mailing Address - Fax:843-831-0173
Practice Address - Street 1:3076 DICK POND RD SUITE #4
Practice Address - Street 2:
Practice Address - City:SURFSIDE BEACH
Practice Address - State:SC
Practice Address - Zip Code:29588
Practice Address - Country:US
Practice Address - Phone:843-831-0163
Practice Address - Fax:843-831-0173
Is Sole Proprietor?:No
Enumeration Date:2006-05-10
Last Update Date:2015-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC4703225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCTH1421Medicaid
SCP01245612OtherRAILROAD MEDICARE PRS 4 LLC
SCP00892030OtherRAILROAD MEDICARE PRS II LLC
SCQ34300A382Medicare PIN
SCQ343007906Medicare PIN
SCQ343009403Medicare PIN
SCP00892030OtherRAILROAD MEDICARE PRS II LLC
SCQ34300C630Medicare PIN