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General NPI Number Information
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NPI Number | 1679723407
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Entity Type | Individual
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Provider Name | AUDREY LAMAR OWENS MSPT
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Gender | Female
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Dates
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Enumeration Date | 09/29/2008
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Last Update Date | 09/29/2008
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Provider Practice Location Address
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Address Line | 100 S SAN MATEO DR
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City | SAN MATEO
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State | CA
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Zip | 94401-3805
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Country | US
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Telephone | 650-696-4012
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Fax |
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Provider Business Mailing Address
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Address Line | 18 FAIRMOUNT ST
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City | SAN FRANCISCO
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State | CA
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Zip | 94131-2768
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Country | US
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Telephone | 415-225-2406
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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 | 2251N0400X
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Taxonomy Name | Neurology Physical Therapist
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License Number | 28998-PT
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License Number State | CA
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