Provider Demographics
NPI:1821282237
Name:OWENS, NANETTE ANN (PTA)
Entity Type:Individual
Prefix:
First Name:NANETTE
Middle Name:ANN
Last Name:OWENS
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6067 PEACE VALLEY RD
Mailing Address - Street 2:
Mailing Address - City:ROGERS
Mailing Address - State:OH
Mailing Address - Zip Code:44455-9757
Mailing Address - Country:US
Mailing Address - Phone:330-457-1113
Mailing Address - Fax:
Practice Address - Street 1:100 COVINGTON DR
Practice Address - Street 2:
Practice Address - City:EAST PALESTINE
Practice Address - State:OH
Practice Address - Zip Code:44413-1007
Practice Address - Country:US
Practice Address - Phone:330-426-2920
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-29
Last Update Date:2019-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PATE006719225200000X
OH04314225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant