MEDICARE: MR. LASCELLS B OWEN P.T.

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
1	225100000X	Physical Therapist	PT18935	FL

General Provider Information

NPI Number	:	1619166808
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. LASCELLS B OWEN P.T.

Provider Business Mailing Address
First Line	:	12506 TEMPLE BLVD
Second Line	:
City	:	WEST PALM BEACH
State	:	FL
Zip	:	33412-2913
Country	:	US
Telephone Number	:	561-784-5412
Fax Number	:

Provider Business Practice Location Address
First Line	:	12506 TEMPLE BLVD
Second Line	:
City	:	WEST PALM BEACH
State	:	FL
Zip	:	33412-2913
Country	:	US
Telephone Number	:	561-784-5412
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/23/2007
Last Update Date	:	10/23/2007

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