Healthcare Provider Details

I. General information

NPI: 1215132311
Provider Name (Legal Business Name): ANGELA M OWENS PT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ANGELA BITTING

II. Dates (important events)

Enumeration Date: 06/19/2007
Last Update Date: 03/08/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

941 VILLAGE TRL
PORT ORANGE FL
32127-9353
US

IV. Provider business mailing address

PO BOX 1975
ROME GA
30162-1975
US

V. Phone/Fax

Practice location:
  • Phone: 386-872-7511
  • Fax: 866-781-1879
Mailing address:
  • Phone: 706-204-8548
  • Fax: 866-781-1879

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT 21667
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: