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General NPI Number Information
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NPI Number | 1669101846
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Entity Type | Individual
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Provider Name | KALLY MARIE OWEN PT, DPT
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Gender | Female
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Dates
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Enumeration Date | 06/06/2022
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Last Update Date | 06/06/2022
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Provider Practice Location Address
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Address Line | 4802 S 109TH EAST AVE
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City | TULSA
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State | OK
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Zip | 74146-5822
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Country | US
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Telephone | 918-392-1400
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Fax |
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Provider Business Mailing Address
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Address Line | 1813 S MAPLEWOOD AVE
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City | TULSA
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State | OK
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Zip | 74112-7218
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Country | US
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Telephone | 580-829-1124
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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 | 2251X0800X
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Taxonomy Name | Orthopedic Physical Therapist
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License Number | PENDING
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License Number State |
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