Provider Demographics
NPI:1285927558
Name:OWENS, SETH M (PT)
Entity type:Individual
Prefix:
First Name:SETH
Middle Name:M
Last Name:OWENS
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1845 E TURNER ST
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65803-4619
Mailing Address - Country:US
Mailing Address - Phone:417-864-5200
Mailing Address - Fax:471-864-5803
Practice Address - Street 1:1845 E TURNER ST
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MO
Practice Address - Zip Code:65803-4619
Practice Address - Country:US
Practice Address - Phone:417-864-5200
Practice Address - Fax:471-864-5803
Is Sole Proprietor?:No
Enumeration Date:2011-05-19
Last Update Date:2016-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2011013605225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO991521005Medicare PIN
MOL35000024Medicare PIN