Healthcare Provider Details

I. General information

NPI: 1407220569
Provider Name (Legal Business Name): HARLAN SCOTT OWENBY DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/30/2015
Last Update Date: 09/07/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 FRIENDSHIP RD
TALLASSEE AL
36078-1265
US

IV. Provider business mailing address

1636 MULBERRY ST
MONTGOMERY AL
36106-1522
US

V. Phone/Fax

Practice location:
  • Phone: 334-283-8032
  • Fax: 334-283-1136
Mailing address:
  • Phone: 334-265-3199
  • Fax: 334-265-3189

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPTH7709
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: