Healthcare Provider Details

I. General information

NPI: 1962735985
Provider Name (Legal Business Name): JAYMIE R OWNBEY PHYSICAL THERAPIST
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/09/2009
Last Update Date: 04/17/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3676 PARKER BLVD SUITE 370
PUEBLO CO
81008-2212
US

IV. Provider business mailing address

PO BOX 9000
PUEBLO CO
81008-9000
US

V. Phone/Fax

Practice location:
  • Phone: 719-553-2209
  • Fax: 719-553-2219
Mailing address:
  • Phone: 719-553-2209
  • Fax: 719-553-2219

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPTL-10433
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: