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NPI Code Detail

MEDICARE: MS. KELLI L OWEN BPT

MEDICARE: MS. KELLI L OWEN BPT
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1225100000XPhysical TherapistPT30256FL
2225100000XPhysical TherapistPT-006691OH

General Provider Information

NPI Number : 1235119843
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. KELLI L OWEN BPT
Provider Business Mailing Address
First Line : 9070 W CHEYENNE AVE STE 100
Second Line :
City : LAS VEGAS
State : NV
Zip : 89129-8935
Country : US
Telephone Number : 702-818-5000
Fax Number : 702-818-5001
Provider Business Practice Location Address
First Line : 17751 MURDOCK CIR
Second Line :
City : PORT CHARLOTTE
State : FL
Zip : 33948-1034
Country : US
Telephone Number : 941-743-8700
Fax Number : 941-743-8850
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/19/2006
Last Update Date : 03/08/2024

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Directions to “ MS. KELLI L OWEN BPT” Practice Location

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