Provider Demographics
NPI:1811040165
Name:OWEN, LINDA CAROL (PT)
Entity Type:Individual
Prefix:MRS
First Name:LINDA
Middle Name:CAROL
Last Name:OWEN
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5265 PROVIDENCE RD
Mailing Address - Street 2:SUITE 503
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23464-4206
Mailing Address - Country:US
Mailing Address - Phone:757-581-4892
Mailing Address - Fax:757-523-4653
Practice Address - Street 1:5265 PROVIDENCE RD
Practice Address - Street 2:SUITE 503
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23464-4206
Practice Address - Country:US
Practice Address - Phone:757-523-4705
Practice Address - Fax:757-523-4653
Is Sole Proprietor?:No
Enumeration Date:2007-01-19
Last Update Date:2016-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305002340225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA239374OtherBC BS
VA650000464Medicare PIN