Healthcare Provider Details

I. General information

NPI: 1689633786
Provider Name (Legal Business Name): MICHAEL CHRISTOPHER OWENS DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/20/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

576 JEFFERSON AVE
FORT EUSTIS VA
23604-1602
US

IV. Provider business mailing address

118 MATTAPONI TRL
WILLIAMSBURG VA
23188-1602
US

V. Phone/Fax

Practice location:
  • Phone: 757-314-7500
  • Fax: 757-314-7517
Mailing address:
  • Phone: 757-565-2213
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number2305204032
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: