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General NPI Number Information
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NPI Number | 1609948090
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Entity Type | Individual
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Provider Name | MONTY OWEN PT
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Gender | Male
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Dates
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Enumeration Date | 11/14/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 4323 E BROADWAY RD SUITE 106
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City | MESA
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State | AZ
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Zip | 85206-3506
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Country | US
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Telephone | 480-854-9833
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Fax | 480-854-9834
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Provider Business Mailing Address
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Address Line | 1823 S ESSEX CIR
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City | MESA
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State | AZ
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Zip | 85209-4015
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Country | US
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Telephone | 480-415-0744
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Fax | 480-854-9834
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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 | 2989
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License Number State | AZ
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Legacy Identifiers
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Identifier #1
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Identifier Code | AZ0297810
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Identifier Type | OTHER
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Identifier State | AZ
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Identifier Issuer | BCBS
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Proprietary Identifiers Ever Reported
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Identifier #1
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Identifier Code | AZ0297810
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Identifier Type | OTHER
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Identifier State | AZ
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Identifier Issuer | BCBS
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