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NPI Code Detail

MEDICARE: MR. PETER CHRISTIAN OWEN LMT

MEDICARE: MR. PETER CHRISTIAN OWEN LMT
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
1225700000XMassage Therapist239620KY

General Provider Information

NPI Number : 1942806997
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. PETER CHRISTIAN OWEN LMT
Provider Business Mailing Address
First Line : 124 KENTUCKY AVE STE 12
Second Line :
City : LEXINGTON
State : KY
Zip : 40502-1755
Country : US
Telephone Number : 270-250-5370
Fax Number :
Provider Business Practice Location Address
First Line : 124 KENTUCKY AVE STE 12
Second Line :
City : LEXINGTON
State : KY
Zip : 40502-1755
Country : US
Telephone Number : 270-250-5370
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/07/2020
Last Update Date : 12/07/2020

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