Provider Demographics
NPI:1881974921
Name:OWENS, NICHOLAS (ATC, LAT)
Entity type:Individual
Prefix:MR
First Name:NICHOLAS
Middle Name:
Last Name:OWENS
Suffix:
Gender:M
Credentials:ATC, LAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17579 ALACK DR
Mailing Address - Street 2:
Mailing Address - City:HAMMOND
Mailing Address - State:LA
Mailing Address - Zip Code:70403-0243
Mailing Address - Country:US
Mailing Address - Phone:985-969-3691
Mailing Address - Fax:
Practice Address - Street 1:389 HIGHWAY 21 STE 403
Practice Address - Street 2:
Practice Address - City:MADISONVILLE
Practice Address - State:LA
Practice Address - Zip Code:70447-3441
Practice Address - Country:US
Practice Address - Phone:985-792-5996
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-21
Last Update Date:2011-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAATH.2001862255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer