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General NPI Number Information
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NPI Number | 1073623708
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Entity Type | Individual
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Provider Name | MRS. TYNISA OWENS
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Gender | Female
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Dates
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Enumeration Date | 08/30/2006
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Last Update Date | 04/20/2020
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Provider Practice Location Address
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Address Line | 3107 W CAMP WISDOM RD STE 950
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City | DALLAS
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State | TX
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Zip | 75237-2643
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Country | US
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Telephone | 214-339-4533
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Fax |
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Provider Business Mailing Address
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Address Line | 1108 KEATS DR
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City | DESOTO
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State | TX
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Zip | 75115-8123
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Country | US
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Telephone | 469-371-3531
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number |
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License Number State |
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