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General NPI Number Information
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NPI Number | 1134642119
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Entity Type | Individual
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Provider Name | CHELSEA OWENS PTA
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Gender | Female
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Dates
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Enumeration Date | 07/20/2017
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Last Update Date | 07/20/2017
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Provider Practice Location Address
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Address Line | 747 S BECKHAM AVE
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City | TYLER
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State | TX
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Zip | 75701-1903
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Country | US
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Telephone | 903-705-4232
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 442
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City | TRINIDAD
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State | TX
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Zip | 75163-0442
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Country | US
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Telephone | 903-340-6741
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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 | 225200000X
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Taxonomy Name | Physical Therapy Assistant
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License Number | 2132476
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License Number State | TX
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