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General NPI Number Information
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NPI Number | 1962021279
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Entity Type | Individual
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Provider Name | JENNIFER MARIE OWENS LMT
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Gender | Female
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Dates
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Enumeration Date | 04/16/2020
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Last Update Date | 04/16/2020
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Provider Practice Location Address
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Address Line | 140 COUNTRY CENTER DR. UNIT 2
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City | PAGOSA SPRINGS
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State | CO
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Zip | 81147
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Country | US
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Telephone | 970-903-9278
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Fax |
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Provider Business Mailing Address
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Address Line | 135 COUNTRY CENTER DR STE F, #111 SUITE F, #111
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City | PAGOSA SPRINGS
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State | CO
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Zip | 81147
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Country | US
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Telephone | 970-903-9278
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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 | 225700000X
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Taxonomy Name | Massage Therapist
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License Number | 21906992
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License Number State | IN
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Taxonomy #2
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Taxonomy Code | 225700000X
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Taxonomy Name | Massage Therapist
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License Number | 0015023
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License Number State | CO
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