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General NPI Number Information
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NPI Number | 1093203879
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Entity Type | Individual
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Provider Name | KAITLYN OWEN DPT
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Gender | Female
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Dates
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Enumeration Date | 04/26/2018
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Last Update Date | 03/26/2021
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Provider Practice Location Address
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Address Line | 1710 E 5600 S
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City | SOUTH OGDEN
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State | UT
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Zip | 84403-4384
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Country | US
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Telephone | 801-689-2546
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Fax |
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Provider Business Mailing Address
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Address Line | 1710 E 5600 S
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City | SOUTH OGDEN
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State | UT
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Zip | 84403-4384
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Country | US
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Telephone | 801-689-2546
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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 | 130546
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License Number State | AK
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Taxonomy #2
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 12139998-2401
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License Number State | UT
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