Healthcare Provider Details

I. General information

NPI: 1003740705
Provider Name (Legal Business Name): KAITLYN OWEN PT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KAITLYN LEYMASTER PT

II. Dates (important events)

Enumeration Date: 06/09/2026
Last Update Date: 06/09/2026
Certification Date: 06/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

905 N CUSTER AVE
GRAND ISLAND NE
68803-4304
US

IV. Provider business mailing address

PO BOX 5285
GRAND ISLAND NE
68802-5285
US

V. Phone/Fax

Practice location:
  • Phone: 308-210-8753
  • Fax: 308-398-5232
Mailing address:
  • Phone: 308-675-1853
  • Fax: 308-210-4121

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number4082
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: