Provider Demographics
NPI:1760095178
Name:OWEN, ELIZABETH CUNNINGHAM (DPT)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:CUNNINGHAM
Last Name:OWEN
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5000 WITTERING DR
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29206-2923
Mailing Address - Country:US
Mailing Address - Phone:803-528-8033
Mailing Address - Fax:
Practice Address - Street 1:3620 COVENANT RD
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29204-4216
Practice Address - Country:US
Practice Address - Phone:803-787-3003
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-25
Last Update Date:2020-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC103542251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics