Healthcare Provider Details

I. General information

NPI: 1548183460
Provider Name (Legal Business Name): OWEN FITZWATER DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/30/2026
Last Update Date: 07/30/2026
Certification Date: 07/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7226 COMMONS DR
CHEYENNE WY
82009-2676
US

IV. Provider business mailing address

4410 STATE ROUTE 49
KNOXVILLE PA
16928-9800
US

V. Phone/Fax

Practice location:
  • Phone: 307-514-5834
  • Fax:
Mailing address:
  • Phone: 814-367-7370
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: