Healthcare Provider Details

I. General information

NPI: 1053220574
Provider Name (Legal Business Name): OWEN HONROTH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/02/2026
Last Update Date: 09/04/2026
Certification Date: 09/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

579 GREENWAY RD STE 102
BOONE NC
28607-4975
US

IV. Provider business mailing address

579 GREENWAY RD STE 102
BOONE NC
28607-4975
US

V. Phone/Fax

Practice location:
  • Phone: 828-865-7227
  • Fax:
Mailing address:
  • Phone: 828-865-7227
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number17309
License Number StateTN
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberCP061967T
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: