Healthcare Provider Details

I. General information

NPI: 1932622016
Provider Name (Legal Business Name): DIANA OWREY MPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/20/2017
Last Update Date: 07/20/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1601 E SAINT ANDREW PL
SANTA ANA CA
92705-4940
US

IV. Provider business mailing address

1387 BOUQUET DR
UPLAND CA
91786-8929
US

V. Phone/Fax

Practice location:
  • Phone: 714-361-6180
  • Fax:
Mailing address:
  • Phone: 714-393-5885
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number30254
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: