Provider Demographics
NPI:1780175968
Name:OWEN, BROOKE LINDSAY (BS IN KINESIOLOGY:)
Entity type:Individual
Prefix:MS
First Name:BROOKE
Middle Name:LINDSAY
Last Name:OWEN
Suffix:
Gender:F
Credentials:BS IN KINESIOLOGY:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1300 N KRAEMER BLVD
Mailing Address - Street 2:
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92806
Mailing Address - Country:US
Mailing Address - Phone:714-630-6363
Mailing Address - Fax:714-630-6318
Practice Address - Street 1:1300 N. KRAEMER BLVD
Practice Address - Street 2:
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92806
Practice Address - Country:US
Practice Address - Phone:714-630-6363
Practice Address - Fax:714-630-6318
Is Sole Proprietor?:No
Enumeration Date:2018-05-23
Last Update Date:2018-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer