Healthcare Provider Details

I. General information

NPI: 1922255264
Provider Name (Legal Business Name): MRS. CASEY LEIGH OWENS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/19/2008
Last Update Date: 08/19/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 WASHINGTON AVE
PHILADELPHIA PA
19147-4335
US

IV. Provider business mailing address

1 WASHINGTON AVE
PHILADELPHIA PA
19147-4335
US

V. Phone/Fax

Practice location:
  • Phone: 215-271-4816
  • Fax: 215-271-4817
Mailing address:
  • Phone: 215-271-4816
  • Fax: 215-271-4817

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code247200000X
TaxonomyOther Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: