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General NPI Number Information
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NPI Number | 1134524820
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Entity Type | Individual
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Provider Name | TYLER OWENS PTA, ATC
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Gender | Male
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Dates
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Enumeration Date | 10/24/2014
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Last Update Date | 08/29/2024
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Provider Practice Location Address
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Address Line | 674 OLLIE AVE
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City | CLANTON
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State | AL
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Zip | 35045-2246
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Country | US
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Telephone | 205-280-1100
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Fax | 205-280-1575
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Provider Business Mailing Address
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Address Line | 674 OLLIE AVE
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City | CLANTON
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State | AL
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Zip | 35045-2246
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Country | US
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Telephone |
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Fax | 205-280-1575
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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 | 225200000X
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Taxonomy Name | Physical Therapy Assistant
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License Number | 11915
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License Number State | AL
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Taxonomy #2
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Taxonomy Code | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number | 1503
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License Number State | AL
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