Provider Demographics
NPI:1427481936
Name:OWEN, JONATHAN (PTA)
Entity type:Individual
Prefix:
First Name:JONATHAN
Middle Name:
Last Name:OWEN
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:360 ROUTE 106 S
Mailing Address - Street 2:
Mailing Address - City:LOUDON
Mailing Address - State:NH
Mailing Address - Zip Code:03307-0822
Mailing Address - Country:US
Mailing Address - Phone:603-785-5225
Mailing Address - Fax:
Practice Address - Street 1:360 ROUTE 106 S
Practice Address - Street 2:
Practice Address - City:LOUDON
Practice Address - State:NH
Practice Address - Zip Code:03307-0822
Practice Address - Country:US
Practice Address - Phone:603-785-5225
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-08-20
Last Update Date:2013-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH1121225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant