Healthcare Provider Details

I. General information

NPI: 1104293745
Provider Name (Legal Business Name): STEPHENS C OWENS P.T.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/31/2015
Last Update Date: 08/31/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

304 MARCELLA RD STE E
HAMPTON VA
23666
US

IV. Provider business mailing address

729 THIMBLE SHOALS BLVD STE 4-C
NEWPORT NEWS VA
23606
US

V. Phone/Fax

Practice location:
  • Phone: 757-825-9446
  • Fax: 757-825-9476
Mailing address:
  • Phone: 757-873-2932
  • Fax: 757-873-8780

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number2305206178
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: