Healthcare Provider Details

I. General information

NPI: 1346674462
Provider Name (Legal Business Name): KIMBERLY ANN OWENS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/26/2013
Last Update Date: 08/26/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

715 E KING ST
SEAFORD DE
19973-3505
US

IV. Provider business mailing address

8365 WOODLAND FERRY RD
LAUREL DE
19956-3851
US

V. Phone/Fax

Practice location:
  • Phone: 302-628-3000
  • Fax:
Mailing address:
  • Phone: 302-381-9274
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License NumberJT-0000871
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: