Provider Demographics
NPI:1396125126
Name:OWEN, KAITLIN (PT,DPT)
Entity type:Individual
Prefix:
First Name:KAITLIN
Middle Name:
Last Name:OWEN
Suffix:
Gender:F
Credentials:PT,DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6005 FERN CT
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28405-4749
Mailing Address - Country:US
Mailing Address - Phone:757-831-4463
Mailing Address - Fax:
Practice Address - Street 1:1409 AUDUBON BLVD
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28403-6749
Practice Address - Country:US
Practice Address - Phone:757-831-4463
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-07
Last Update Date:2025-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP15676225100000X
NC15676225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1396125126Medicaid