Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 225100000X | Physical Therapist | 009431 | OH |
Y | 2251G0304X | Physical Therapist - Geriatrics | 004451 | KY |
NPI | 1053504365 |
---|---|
Provider Name | Mrs. Kristi Marie Owen |
First Address | Elsmere, KY 41018-2838 |
Second Address | Elsmere, KY 41018-2838 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/08/2007 |
Last Update Date | 20/08/2007 |