MEDICARE: TANE OWENS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist

General Provider Information

NPI Number	:	1033644901
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TANE OWENS

Provider Business Mailing Address
First Line	:	202 W PROSPECT AVE
Second Line	:	APT 3
City	:	PIERRE
State	:	SD
Zip	:	57501-2034
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3213 W CHARLESTON BLVD STE 105
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89102-1991
Country	:	US
Telephone Number	:	702-570-6222
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/27/2017
Last Update Date	:	04/27/2017

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Directions to “ TANE OWENS ” Practice Location

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