Provider Demographics
NPI:1922272905
Name:OWEN, DEBORAH A, (PTA)
Entity Type:Individual
Prefix:
First Name:DEBORAH
Middle Name:A,
Last Name:OWEN
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 1:6325 N CENTER DR
Mailing Address - Street 2:BUILDING 18, SUITE 100
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23502-4010
Mailing Address - Country:US
Mailing Address - Phone:804-523-2653
Mailing Address - Fax:804-783-8212
Practice Address - Street 1:6325 N CENTER DR
Practice Address - Street 2:BUILDING 18, SUITE 100
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23502-4010
Practice Address - Country:US
Practice Address - Phone:804-523-2653
Practice Address - Fax:804-783-8212
Is Sole Proprietor?:No
Enumeration Date:2008-04-21
Last Update Date:2008-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2306000333225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant