MEDICARE: TRISTAN OWENS

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	PT31013	FL

General Provider Information

NPI Number	:	1619341419
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TRISTAN OWENS

Provider Business Mailing Address
First Line	:	3322 SAWTOOTH DR
Second Line	:
City	:	TALLAHASSEE
State	:	FL
Zip	:	32303-7368
Country	:	US
Telephone Number	:	850-570-3036
Fax Number	:

Provider Business Practice Location Address
First Line	:	3322 SAWTOOTH DR
Second Line	:
City	:	TALLAHASSEE
State	:	FL
Zip	:	32303-7368
Country	:	US
Telephone Number	:	850-570-3036
Fax Number	:

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

Provider Enumeration Date	:	11/17/2015
Last Update Date	:	11/25/2015

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