Healthcare Provider Details

I. General information

NPI: 1033040316
Provider Name (Legal Business Name): ELIZABETH LEANNE OWEN LMT AL#3907
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/26/2026
Last Update Date: 05/26/2026
Certification Date: 05/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5510 WARES FERRY RD STE G
MONTGOMERY AL
36117-2129
US

IV. Provider business mailing address

632 E EDGEMONT AVE
MONTGOMERY AL
36111-1323
US

V. Phone/Fax

Practice location:
  • Phone: 205-613-7214
  • Fax:
Mailing address:
  • Phone: 205-613-7214
  • Fax: 205-613-7214

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number3907
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: