Provider Demographics
NPI:1255570206
Name:OWEN, SAMANTHA J (LPTA)
Entity type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:J
Last Name:OWEN
Suffix:
Gender:F
Credentials:LPTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3616 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:ROCKFORD
Mailing Address - State:IL
Mailing Address - Zip Code:61103-2159
Mailing Address - Country:US
Mailing Address - Phone:815-877-5932
Mailing Address - Fax:815-877-6302
Practice Address - Street 1:3616 N MAIN ST
Practice Address - Street 2:
Practice Address - City:ROCKFORD
Practice Address - State:IL
Practice Address - Zip Code:61103-2159
Practice Address - Country:US
Practice Address - Phone:815-877-5932
Practice Address - Fax:815-877-6302
Is Sole Proprietor?:No
Enumeration Date:2009-02-16
Last Update Date:2009-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant