Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | 40QA00572700 | NJ |
N | 2251S0007X | Physical Therapist - Sports | 40QA00572700 | NJ |
N | 2251X0800X | Physical Therapist - Orthopedic | 40QA00572700 | NJ |
NPI | 1366407611 |
---|---|
Provider Name | Ms. Nicola A Owen |
First Address | Moorestown, NJ 08057-4602 |
Second Address | Northfield, NJ 08225-1809 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/04/2006 |
Last Update Date | 04/04/2019 |